Pain during burn dressing change in children: relationship to burn area, depth and analgesic regimens

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Abstract
The body surface area (BSA) burned suggests that pain increases with the size of the burn. Contrary to widely held beliefs, comparison of mean pain scores and the percent of 3rd degree burn revealed that the larger the area of full-thickness injury, the greater the pain. Regardless of wide variations in patient characteristics, fixed doses of oral narcotics were usually prescribed for pain. Patients with BSA > 70% experienced severe pain during BDC despite the type, dose or route of opioids. These findings suggest the need for (a) education to correct the myth that ‘third-degree burns don't hurt’ (b) revision of analgesic prescribing patterns in the burned child (c) research to determine the mechanisms (e.g., tolerance or deafferentation) underlying the opioid-resistant nature of pain after large burns. ∗Correspondence to: Ms. N.E. Atchison, Shriners Burns Institute, 51 Blossom Street, Boston, MA 02114, U.S.A. Submitted January 17, 1990; revised February 1, 1991; accepted February 28, 1991. © Lippincott-Raven Publishers....

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