A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

Abstract

Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

State of the Art: An Update on Adult Burn Resuscitation

“…Ketamine has been shown to have an opiate-sparing effect in burn-injured patients, and a favorable hemodynamic profile (short of the anesthetic induction dose) in most patients with shock [125,126]. A multi-modal regimen is preferred so as to limit dose-dependent effects and to target multiple paintransducing pathways [127]. It is also important to note alterations of pharmacokinetics and pharmacodynamics.…”

Challenges in anaesthesia and pain management for burn injuries

“…106 Evidence is emerging for alternative nonpharmacological adjuncts for managing procedural pain, with trials showing positive results using hypnosis, 107 virtual reality and interactive gaming consoles, music and transcranial direct current stimulation. 108 Distress during the acute event resulting from pain and insomnia can contribute to worse psychological outcomes with the likelihood of chronic depression, suicidal ideation and poorer quality of life measures found to be increased out to two years. 109 Sleep dissatisfaction can occur in up to 50% of young adult burn survivors for several years following discharge from the burn unit.…”

Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review

“… 6 There are also co-adjuvant drugs that act on the receptors of the nociceptive pathways and have an additive or synergic action, 7 such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), ketamine, lidocaine, and gabapentinoids. 8 …”