Comparison of Pain Severity and Management in Burn and Nonburn Trauma Patients

Abstract

Burn injuries are generally considered to be among the most painful. However, there is little evidence to support this. It is also unknown if pain management in burn patients differs from patients with other sources of pain. We compared pain severity among patients presenting to emergency departments (EDs) across the United States with burn and nonburn injuries using data generated from the National Hospital Ambulatory Care Survey. Multivariate analyses was performed to determine the association between predictor variables and pain severity as well as pain management in the ED. Of the estimated 527 million ED visits between 2010 and 2013, 2.1 million were due to burns and 128 million were due to nonburn trauma. Mean (SE) initial pain scores by patient group were burns 6.3 (0.27), nonburn trauma 5.4 (0.04), and nontrauma 4.8 (0.04), P < .001. Mean (95% confidence interval) pain scores by specific type of injury were burns 6.4 (5.9-6.9), fractures 6.7 (6.6-6.9), dislocations 6.7(6.3-7.1), and sprains/strains 6.8 (6.7-6.9), P < .001. Pain scores were higher for males and increased with age. Adjusted for age and gender, burns had the smallest effect of all types of injuries on pain score except for open wounds, contusions, and crush injuries. Patients with fractures and dislocations were more likely to receive an opioid than burn patients after adjusting for pain severity. We conclude that pain severity due to burns is no greater than due to dislocations, fractures, and sprains/strains and that burn patients are less likely to receive opioid and nonopioid analgesics than fractures and dislocations.

Multi‐Functional Small Molecule Alleviates Fracture Pain and Promotes Bone Healing

“…These include reduced weight bearing, decreased rearing, and increased mechanical, thermal, and cold allodynia in mice. [ 9 , 19 ] Fractures produce an array of inflammatory cytokines, chemokines, neurotrophins, and neurokines that have been shown to contribute to inflammatory pain. [ 8 ] One such molecule is nerve growth factor (NGF) which is upregulated following fracture and its inhibition has been shown to attenuate fracture pain.…”

“…[ 8 ] One such molecule is nerve growth factor (NGF) which is upregulated following fracture and its inhibition has been shown to attenuate fracture pain. [ 7 , 9 ] The nociceptive effect of NGF is partially due to its role in promoting the translocation of Transient Receptor Potential Cation Channel Subfamily V Member 1 (TRPV1) to the cell surface membrane and upregulation of TRPV1 expression. [ 20 ] Studies have found that TRPV1‐expressing neurons in L3 and L4 DRG are pivotal to nociception associated with bone trauma and bone cancer of rodent hindlimbs.…”

“…We observed increased TRPV1 expression in DRG neurons after injury, and higher expression and functional activity of dissociated DRG neurons cultured in presence of NGF, a neurokine that is elevated in the fracture microenvironment. [ 7 , 9 , 28 ] TRPV1 has been shown to play a significant role in inflammatory pain [ 29 ] that sensitizes C and Aδ fiber bone afferent neurons. [ 21a ] Its elevated expression after bone injury correlates with elevated levels of several inflammatory molecules.…”

“…[ 8 ] As a result, bone trauma is associated with significant pain requiring the use of analgesics. [ 2 , 9 ] While analgesics, such as NSAIDs and opioids, are effective in managing acute pain, their use often leads to unwanted side effects. In addition to interfering with healing, use of NSAIDs and opioids can also result in gastrointestinal irritation and constipation.…”

A multi-functional small molecule alleviates fracture pain and promotes bone healing

“…These changes in peripheral nerves could be attributed to an increase in neurotrophins, neuropeptides, and inflammatory molecules that play key roles in fracture healing but also contribute to induction, sensitization, and maintenance of pain (15)(16)(17). As a result, bone trauma is associated with significant pain requiring use of analgesics (2,18,19). While analgesics such as NSAIDs and opioids are effective to manage acute pain, their use often leads to unwarranted side effects.…”