David R. Patterson University of Washington School of Medicine
Jason N. Doctor University of Washington School of Medicine
Sam R. Sharar University of Washington School of Medicine
A substantial portion of the world's population experiences severe burn injury. In the United States alone, burn injuries are thought to account for approximately 500,000 emergency room visits, 54,000 hospital admissions, and 5,500 deaths annually ( Brigham & McLoughin, 1996). Patients in such circumstances will typically experience pain greater than or equal to that produced by almost any other etiology. The pain associated with the initial injury is often incomparable; yet, the pain experienced during treatment for burn injury is frequently worse. Further, painful burn treatments are seldom a one-time occurrence, and patients must often experience such suffering on a daily basis until the wound is healed. Because burn pain is intense, repeated, and unpredictable, its treatment represents a formidable challenge for clinicians working in this area of trauma care. The extent and severity of burn pain, however, also provides a valuable setting for studying acute pain relevant to a variety of other etiologies. The ensuing discussion addresses burn pain with respect to (a) medical and psychological conditions, (b) quantitative and qualitative aspects of burn pain, (c) pathophysiology, and (d) treatment.
Sufficiently large and/or severe burn injuries, without appropriate treatment, can result in severe disfigurement, amputation, or death. Modern burn care has done much to improve survival after such injuries through