Treatment of Pain in Acutely Burned Children

Abstract

The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.

Equipe de saúde e o brincar da criança com queimaduras

“…Pesquisadores destacam a importância das atividades lúdicas para as crianças hospitalizadas que são submetidas aos tratamentos dolorosos no corpo (Stoddard et al, 2002). As queimaduras ocasionam nas crianças hospitalizadas mudanças fisioló-gicas e psicológicas que têm repercussões, durante o tratamento, nos seguintes aspectos: relacionamento com a equipe de saúde e a família, dificuldades para reconhecer a importância dos procedimentos técnicos e problemas relacionados à autoimagem.…”

“…A dor representa um fenômeno vivenciado pelos pacientes hospitalizados com queimaduras; dessa forma, o acompanhamento psicológico se torna fundamental para a criança e sua família. Stoddard et al (2002) destacam que as intervenções psicológicas reduzem o nível de estresse da criança hospitalizada e permitem auxiliar o manejo das sensações dolorosas.…”

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children

“…The stress of inpatient treatment, specifically a burn dressing change, has been compared with ''inescapable shock'' or ''learned helplessness'' for pediatric burn patients. 31 The Pediatric Acute Wound Service (PAWS) has been developed at our institution, and it allows for inpatient and outpatient surgical management of various soft tissue conditions. We find it to be an ideal unit where traumatic wounds, which otherwise would be historically managed in the operating room or inpatient hospital setting, can be evaluated and managed.…”

“…31 Saxe et al showed that one pathway to PTSD was mediated by separation anxiety and this was, in turn, influenced by the acute pain response. 10 Stoddard et al found that parents' acute stress of having a child in pain influenced the child's own acute stress symptoms.…”

“…Stoddard et al discussed that the physiological impact of pain through hormone-mediated catabolic stress response involves diminished immune function and impaired wound healing in burn patients. 31 Within the PAWS model, pediatric patients with their burn dressing intact come to the treatment room with their parents and are sedated in the parents' presence. Once sedated, the burn dressing is removed and then, any needed burn debridement takes place.…”