Pain managment and analgesia

First Aid

20 minutes of cool running water, effective within 3 hours after sustaining a burn injury.

Pain management and analgesia

Managing pain during wound dressing is essential to ensure the procedure is made as comfortable for the patient as possible. In order to prepare the wound the patients’ pain must be considered.

There are two considerations for pain management with minor burns

Background pain i.e. pain at rest
Breakthrough i.e. Pain that is suddenly exacerbated, usually related to an activity or movement
Procedural pain i.e. pain experienced during wound dressings or assessment

Oral Procedural pain relief should be administered at least 45 minutes prior to wound dressing or manipulation procedures. Patients can feel pain as a result of their procedure for hours after.

Adult Analgesic Guidelines

The following provides a recommended short term (<72 hours) oral analgesia guidelines for the management of superficial burn injury.

Mild - pain score 0-3

Paracetamol 1g oral 6/24 hrs PRN
Celecoxib 100-200mg BD (unless contraindicated) +/- Gut protection

Moderate - pain score 4-7

Add: Instant Release Opioid Endone
Use age appropriate doses, if < 70 years: 5mg every 3 hours PRN

Severe - pain score 8-10

Add: Slow Release Opioid (Targin) & Instant Release Opioid (Endone)
Add: Pregabalin 75mg BD
Consider Admission IV analgesic
Instant Release: Use age appropriate doses, if < 70 years: 5-10mg every 3 hours PRN

General advice:

Aim for pain scored of 4 or less at rest
Analgesia should be reviewed after 72 hours
Use clinical judgement
Use age to guide opiod doses, lower doses in the frail/elderly. Start with PRN immediate release