Differences in Patient Characteristics for Developing Acute Pain versus Chronic (Neuropathic) Pain Following Burn Injury
Kevin M. Klifto, PharmD, A. Lee Dellon, MD, PhD, C. Scott Hultman, MD, MBA.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BACKGROUND: Pain, unrelated to the initial trauma itself, can result following burn injury. This pain may be acute and self-limiting or chronic, and contribute to long-term patient morbidity. The purpose of this study was to compare burn patients who had only acute pain to burn patients who developed chronic, neuropathic pain and determine risks factors for progression from the acute to chronic pain in the setting of an adult burn center.
METHODS: A single-center, retrospective chart review of patients admitted to the adult burn center was performed from January 1, 2014 through January 1, 2019. Patients included were over the age of fifteen years, sustained a burn injury and admitted to the burn unit. Chronic pain was defined as pain lasting greater than 6 months following onset of burn. Pain was diagnosed and described as shooting, stabbing, sharp, burning, tingling, numbness, intermittent and/or continuous dysesthetic sensations following the burn. Patients were excluded if they had pre-existing neuropathic pain due to an underlying medical illness.
RESULTS:Over a five-year period, of the 1880 admissions to the burn unit, 143 burn patients developed post-initial onset pain as a direct result of their burn. Of the 143 patients with acute pain, pain resolved in 30 patients while 113 patients progressed to chronic pain. Patient follow-up was meanąSD=26.8ą16, and median(IQR)=26.5(10-45) months.
Patients who progressed to chronic pain had significantly greater percent total body surface area burns (%TBSA) [meanąSD=16ą19, median(IQR)=6(3-25), vs. meanąSD=9.5ą15, median(IQR)=3(1-10), p=0.032], more third degree burns [66/113 (58%) vs. 8/30 (27%) patients, p=0.004], had surgery [85/113 (75%) vs. 16/30 (53%) patients, p=0.042], had more surgical procedures [meanąSD=4.5ą7, median(IQR)=2(1-6), vs. meanąSD=1.6ą3, median(IQR)=1(0-3), p=0.002], and developed more complications [32/113 (28%) vs. 2/30 (7%) patients, p=0.014], compared to those with only acute neuropathic pain, respectively. CONCLUSIONS: Burn patients who progressed from acute to chronic neuropathic pain had significantly greater %TBSA burns, more third degree burns, had surgery, had more surgical procedures, and developed more complications than burn patients with only acute pain.
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