Research shows that patients with burns can develop chronic pain that is sometimes unrelated to the initial burn itself. Chronic neuropathic pain (CNP) can develop after partial or complete peripheral nerve injuries among this patient population. This pain can significantly decrease quality of life (QOL) and often leads to long-term morbidity that limits functional recovery.
“Previous studies report that the prevalence of CNP following burns ranges from 7.3% to 82.0% spanning the years of 1989 to 2013,” says Kevin M. Klifto, PharmD. “Considering this wide range, a better understanding of the true prevalence of CNP following burns and associated predictors of CNP may help healthcare providers (HCPs) in their care of these patients. Some HCPs may be unaware of the signs and symptoms of burn-related neuropathic pain or how it impacts QOL. Furthermore, chronic pain—regardless of its origin—often has a stigma associated with opioid-seeking behavior, and many patients do not receive the appropriate attention they may deserve.”
Prevalence & Risk Factors for CNP
For a study published in Burns & Trauma, Dr. Klifto and colleagues sought to determine the prevalence and associated predictors for CNP in patients with burns. The retrospective analysis included 1,880 patients older than 15 who were admitted to an adult burn center between 2014 and 2019. CNP was diagnosed clinically following the burn injury. Data from patients admitted to the burn center with no pain were then compared with data from those admitted to the burn center who subsequently developed CNP. The median patient follow-up was 27 months.
“A goal of our study was to determine the prevalence of CNP among patients with burns, but we also wanted to identify risk factors associated with CNP following burns,” says Dr. Klifto. “By identifying factors that contribute to CNP, HCPs could potentially predict who might develop this pain and seize opportunities for earlier interventions to prevent long-term suffering and potentially improve a patient’s QOL.”
According to the results, 113 burn patients—or 6.01%—developed CNP as a direct result of their burn injury during the 5-year study. Patients who developed CNP were significantly older, with a median age of 54, compared with a median age of 46 in the no-pain group. “Patients with burns who developed CNP were more likely to abuse alcohol or other substances and were more likely to be current smokers,” Dr. Klifto says (Table). “We also found that a greater number of burn-related surgeries and longer hospital length of stay (LOS) were associated with developing CNP.” In addition, patients who developed CNP suffered more full-thickness burns, had a greater percent of total body surface area burns, and were more often intubated on mechanical ventilation.
Awareness & Prevention
When managing burn injuries, Dr. Klifto notes that public awareness and prevention are important considerations. “Alcohol abuse, substance abuse, and/or smoking may increase risks for developing CNP following a burn, but these are all potentially modifiable risk factors that patients can address by making lifestyle changes,” he says. “However, the number of surgeries and hospital LOS may not be modifiable depending on the extent of the burn injury and other comorbidities. In these cases, preventative measures or more frequent follow-up visits may be helpful to monitor for signs and symptoms of CNP and allow HCPs to potentially provide early interventions.”
In light of the findings, Dr. Klifto says additional prospective studies that monitor the identified predictors of CNP in patients with burns may provide more conclusive insights. “It would also be helpful to determine the number of surgeries and number of days in the hospital that favor risks over benefits so that we can provide guidance for HCPs managing acutely burned patients,” he says. “In addition, investigating the early initiation of preventative therapies in high-risk patients may help us better understand the pathophysiology involved with developing CNP following burns. As these data emerge, we hope to improve our care of patients with burns and reduce their risks for developing CNP.”
Klifto KM, Dellon AL, Hultman CS. Prevalence and associated predictors for patients developing chronic neuropathic pain following burns. Burns Trauma. 2020;8:tkaa011. Available at: https://academic.oup.com/burnstrauma/article/doi/10.1093/burnst/tkaa011/5818502.
Browne AL, Andrews R, Schug SA, Wood F. Persistent pain outcomes and patient satisfaction with pain management after burn injury. Clin J Pain. 2011;27:136-145.
Tamam Y, Tamam C, Tamam B, Ustundag M ,Orak M ,Tasdemir N. Peripheral neuropathy after burn injury. Eur Rev Med Pharmacol Sci. 2013;17:107-111.