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A Descriptive Review of Neuropathic-Like Pain After Burn Injury

Schneider, Jeffrey C. MD*; Harris, Natalie L. RN†; Shami, Amir El BA‡; Sheridan, Robert L. MD‡§; Schulz, John T. III MD, PhD¶; Bilodeau, Mary-Liz RN, MS†; Ryan, Colleen M. MD†§

doi: 10.1097/01.BCR.0000226019.76946.5D
Original Articles

This study reviews the natural history of neuropathic-like pain after burn injury. We undertook a retrospective chart review during a 24-month period of patients treated at an outpatient burn center. The medical records of patients with neuropathic-like pain complaints, including the sensation of pins and needles, burning, stabbing, shooting, or “electric” sensations, were included for analysis. Medical and demographic data were collected. We identified 72 patients for inclusion in the study. The age was 44 ± 2 years (mean ± SEM), and TBSA burned was 18 ± 3%. The first complaint of neuropathic-like symptoms was at 4.3 ± 0.5 months after injury. Documentation of improvement in the symptoms occurred at 7.0 ± 0.8 months. Symptoms persisted for 13.1 ± 2.2 months after the injury. Patients were followed for 14.5 ± 2.2 months. Documented initial pain severity score was 7 ± 1 of 10. Typical exacerbating factors included temperature change, dependent position, light touch, and weight-bearing activities. Common alleviating factors included rest, massage, compression garment use, and elevation. Treatment regimens often included gabapentin (38%) and steroid injections (21%). Hypertrophic scarring (43%), pruritis (40%), and psychiatric diagnoses (36%) were common associated problems. There is a patterned natural history for neuropathic-like pain after burn injury. This clinical entity involves significant pain complaints and persists, on average, for greater than 1 year after injury, which underscores the importance of long-term outpatient care after burn injury. Furthermore, an understanding of the natural history will assist clinicians in prognosticating and caring for burn survivors with pain after wound closure.

From the *Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; †Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ‡Rosalind Franklin University of Medicine and Science, The Chicago Medical School, Chicago, Illinois; §Shriners Burns Hospital, Boston, Massachusetts; and ¶Section of Trauma, Burns, and Surgical Critical Care, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, Connecticut.

Address correspondence to Colleen M. Ryan, MD, Co-Director, Sumner Redstone Burn Center, Bigelow 1302, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.

© 2006 The American Burn Association