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Chronic Pain and Itch are Common, Morbid Sequelae Among Individuals Who Receive Tissue Autograft After Major Thermal Burn Injury

Mauck, Matthew C. MD, PhD*,†; Smith, Jennifer MD*,†; Liu, Andrea Y. BS*,†; Jones, Samuel W. MD; Shupp, Jeffrey W. MD§; Villard, Marie A. BA*,†; Williams, Felicia MD; Hwang, James MD; Karlnoski, Rachel PhD; Smith, David J. MD; Cairns, Bruce A. MD; Kessler, Ronald C. PhD; McLean, Samuel A. MD, MPH*,†,#

The Clinical Journal of Pain: July 2017 - Volume 33 - Issue 7 - p 627–634
doi: 10.1097/AJP.0000000000000446
Original Articles

Objective: Pain and itch symptoms are common after major thermal burn injury (MThBI)—requiring tissue autografting. To our knowledge, no prospective longitudinal studies have characterized pain and itch outcomes after tissue autografting and associations between and functional interference caused by such symptoms.

Materials and Methods: We prospectively evaluated burn graft site and tissue donor site pain and itch severity (0 to 10, numeric rating scale) over 1 year among a representative cohort of MThBI survivors (n=96) who received tissue autografting within 14 days of MThBI.

Results: Nearly all participants had moderate or severe burn pain at the time of enrollment. Most individuals experienced an upper extremity burn with donor tissue taken from thigh. Persistent moderate or severe burn graft site pain declined thereafter, but remained common, with 25/90 (28%), 24/77 (31%), and 17/82 (21%) experiencing moderate or severe pain at 6 weeks, 3 months, and 6 months, respectively. Although there was improved function after immediate postinjury decline in all participants, those who had moderate or severe pain showed worse functional outcomes at each timepoint. Significant correlations were present between itch and pain burden over time at the same site (ie, autograft site r=0.629, P<0.01) and also across sites (ie, autograft and donor site itch r=0.552, P<0.01).

Discussion: Pain and itch are common after MThBI, are temporally and spatially concordant and cause significant impact on daily function. Further studies are needed to better understand pain and itch symptom pathogenesis after MThBI, to reduce the tremendous suffering and decline.

*TRYUMPH Research Program

Departments of Anesthesiology

#Emergency Medicine

Jaycee Burn Center, University of North Carolina, Chapel Hill, NC

§The Burn Center, MedStar Washington Hospital Center, Washington, DC

Department of Surgery, University of South Florida, Tampa, FL

Department of Health Care Policy, Harvard Medical School, Boston, MA

Supported by the Department of Anesthesiology University of North Carolina, Chapel Hill North Carolina and the Jaycee Burn Center, University of North Carolina, Chapel Hill, North Carolina, and DC Firefighters Burn Foundation, Washington, DC. The authors declare no conflict of interest.

Reprints: Samuel A. McLean, MD, MPH, Department of Anesthesiology, University of North Carolina, Medical School Wing C CB#7010, Chapel Hill, NC 27599-7010 (e-mail:

Received June 24, 2016

Received in revised form February 27, 2017

Accepted October 1, 2016

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