Burns

This chapter focuses primarily on thermal burns, but presents some brief points about related injuries. While the burn causes intense pain, thermal injury causes significant local and systemic responses that may both potentiate the pain from additional stimuli and alter the physiologic response to medication. This chapter focuses on pharmacologic approaches to analgesia. A survey of North American burn centers found that IV morphine is the most frequently used analgesic for wound care. While minor burn pain may be managed with acetaminophen or NSAIDs, opioids are the mainstay of therapy for moderate-to-severe burn-associated pain. Anxiolytics, particularly benzodiazepines, are useful adjuncts to pain therapy in burns. Lorazepam and midazolam are widely used for burn patients. A small pilot study of 10 patients suggested that the analgesic qualities of oral controlled-release morphine were comparable to those of continuous IV morphine sulfate infusions.