BURN PAIN

Abstract

INTRODUCTION

A burn is the destruction of the skin, disrupting its vital functions due to the local action of heat exceeding 40°C, which denatures proteins through tissue destruction.

It is the most unbearable, intense, and prolonged type of pain, requiring a painful, complex, and multifaceted treatment with multiple components, making it difficult to control. It presents through two pathways: vascular damage leading to hypoxia secondary to the burn, and stimulation of primary nociceptors. It is characterized by four pain syndromes: Background Pain, Breakthrough Pain, Procedure Pain, and Chronic Pain.

OBJECTIVE

This clinical case allows us to identify the importance of proper assessment and pharmacological management of pain, thus achieving control of acute burn pain and preventing chronic pain.

CLINICAL CASE

On September 12, 2025, a 23-year-old woman was presented to us. Her symptoms began on August 15, 2024, when she suffered burns from boiling water. She went to a general hospital where surgical debridement was performed, but skin grafting was not possible. For this reason, she came to our INR LGII (National Institute of Rehabilitation, LGII). During our evaluation, she reported pain localized to her lower extremities and left forearm. She denied radiation, describing the pain as sharp, burning, and oppressive, constant, and intense. Her pain was rated 9/10 on the pain scale, increasing to 10/10 with movement and wound care, and decreasing when the area was not touched. Her vital signs were within normal limits. On physical examination, she was alert and oriented in all three spheres, very apprehensive, with no signs of respiratory distress. Lung fields showed good air entry and exit, heart sounds were rhythmic, and her abdomen was soft and non-tender with no signs of peritoneal irritation.

DIAGNOSIS

Scald burn covering 36% TBSA, mixed 2nd degree on the chest, mixed 3rd and 2nd degree on the lower extremities and buttocks

DISCUSSION

We initiated pharmacological treatment with morphine 15mg in 100ml of normal saline over 24 hours, at 4.1ml/hour, with rescue doses of morphine 2mg IV, maximum 3 in 24 hours, and pregabalin 75mg every 24 hours. From September 13th to 17th, at 7:00 PM, the patient reported a NAS score of 3/10 without the need for rescue doses. The patient has undergone 2 surgical interventions. On September 18th, we reduced the morphine infusion to 10mg, with the same rescue doses, and added paracetamol 1g IV every 8 hours. We observed Graft integration, without deepening of donor sites. On October 8th, we performed oral equianalgesia with tramadol and paracetamol [37.5mg + 325mg] every 8 hours, with rescue doses of tramadol solution (10-15 drops). For patients with a NAS score greater than 7/10, a maximum of 3 times a day, pregabalin 75mg every 24 hours and paracetamol 500mg every 8 hours were also administered.

CONCLUSION

The treatment to control burn pain is surgical, involving grafting. Pain decreases by 80% after 2 weeks. Pharmacological treatment (multimodal analgesia) is also used, along with cognitive-behavioral therapy.