Neuropathic Mechanisms in the Pathophysiology of Burns Pruritus

Abstract

Pruritus in burn wounds is a common symptom affecting patient rehabilitation. Over the last decades, there has been a resurgence of interest into more effective strategies to combat this distressing problem; nevertheless, no reports exist in the literature to propose pathophysiological mechanisms responsible for the generation and persistence of pruritic symptoms in the late phases of burns rehabilitation. Neuronal pathways mediating pruritic and painful stimuli share striking similarities, which allows the comparative exploration of the less extensively studied pruritic mechanisms using pain models. Furthermore, emerging anatomical, neurophysiological, and pharmacological evidence supports the involvement of neuropathic mechanisms in chronic burns pruritus. This work updates the conceptual framework for the pathophysiology of burns itch by embracing the contribution of the central nervous system in the maintenance of symptoms into a chronic state. The proposed pathophysiological model paves new avenues in burns pruritus research and is likely to have implications in the quest for more effective therapeutic regimens in clinical practice.

Pruritus in Pediatric Burn Survivors

“…[28][29][30] A pediatric observational study using the Unna boot demonstrated fewer itch symptoms as well as reduced dressing change time, lower cost of dressings, and better appetite, sleep, and play patterns. 22,26 In a pilot study, the administration of loratadine provided subjective relief of itching for all patients. 27 Additional research is needed to assess treatment options for pruritus in the pediatric population.…”

“…The following interventions have been examined in the adult burn population with varying levels of evidence: antihistamines (H1 receptor antagonists, both oral and topical); antiepileptics (gabapentin and pregabalin); tricyclic antidepressants (topical doxepin); noninvasive brain stimulation techniques such as transcranial direct current stimulation; and nonmedication interventions such as emollients (aloe vera, lanolin) and massage therapy. [20][21][22][23][24] The only treatments that have been assessed in children include gabapentin, a eutectic mixture of local anesthetics (EMLA), the Unna boot, and loratadine. 20,22,[25][26][27] Researchers demonstrated a significant reduction in itch symptoms within 24 hours of receiving gabapentin in the pediatric burn population.…”

“…[20][21][22][23][24] The only treatments that have been assessed in children include gabapentin, a eutectic mixture of local anesthetics (EMLA), the Unna boot, and loratadine. 20,22,[25][26][27] Researchers demonstrated a significant reduction in itch symptoms within 24 hours of receiving gabapentin in the pediatric burn population. 20 EMLA was shown to reduce the number of pruritic episodes on the day in which it was administered.…”

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

“…740 Nilius and Szallasi The similarities and differences between itch and pain sensation (Fig. 28) are only beginning to be understood (reviewed in Goutos, 2013). We scratch ourselves until it hurts to relieve itch, suggesting a common neuronal pathway for pain and itch (Akiyama et al, 2012).…”

Itch in Burn Areas After Skin Transplantation: Patient Characteristics, Influencing Factors and Therapy

“…Thus, it is now assumed that both an increase of mediators and neuronal damage caused by deep dermal burns, contribute to the pruritic symptoms (15). Although the evidence for involvement of the central nervous system in itch Itch in Burn Areas After Skin Transplantation: Patient Characteristics, Influencing Factors and Therapy perception can not be ignored (16), all these studies suggest that processes at the skin level may have a role in itching but few studies investigated itch at body location level and investigated more thoroughly the role of skin grafting.…”