Abdi Salahadin, Zhou Yili
Department of Anesthesiology and Critical Care, Massachusetts General Hospital Pain Center, Boston, Massachusetts 02114, USA.
Curr Opin Anaesthesiol. 2002 Oct;15(5):563-7. doi: 10.1097/00001503-200210000-00015.
Burn pain is often under treated. Burn patients suffer from daily background pain as well as procedural pain. Direct mechanical and chemical stimulation to peripheral nociceptors, peripheral- and central sensitization contribute to the pathophysiology of pain. The purpose of this review is to discuss the current management of burn pain and also to stimulate future studies.
Background pain is best treated with mild to moderate potent analgesics administered regularly to maintain a steady plasma drug concentration. Procedural pain should be treated vigorously with intravenous opioids, local or even general anesthesia if needed. Opioids are the mainstay of treatment for severe acute pain. PCA should be used wherever applicable. Further opioids should not be substituted by high dose NSAIDs in the management of procedural pain. Hypnosis, therapeutic touch, massage therapy, distracting techniques and other behavioral cognitive techniques have demonstrated some intriguing impact on acute as well as chronic burn pain treatment.
There is no clear evidence to show that the use of opioids in acute pain may increase the likelihood of developing opioid dependency. Thus, pain after burn injury should be aggressively treated using pharmacologic and non-pharmacologic approaches. Further controlled studies are yet to be conducted to define appropriate treatments for different burn patients and to establish standard treatment protocols for burn pain.
烧伤疼痛常常未得到充分治疗。烧伤患者不仅遭受日常的背景疼痛，还经历诊疗过程中的疼痛。对周围伤害感受器的直接机械和化学刺激、外周和中枢敏化作用均参与了疼痛的病理生理过程。本综述旨在探讨烧伤疼痛的当前治疗方法，并激发未来的研究。
背景疼痛最好通过定期给予轻度至中度强效镇痛药来治疗，以维持稳定的血浆药物浓度。诊疗过程中的疼痛应积极治疗，必要时可使用静脉注射阿片类药物、局部甚至全身麻醉。阿片类药物是治疗严重急性疼痛的主要药物。应在适用的情况下使用患者自控镇痛（PCA）。在诊疗过程中疼痛的管理中，不应使用高剂量非甾体抗炎药替代阿片类药物。催眠、治疗性触摸、按摩疗法、分散注意力技术及其他行为认知技术已证明对急性和慢性烧伤疼痛治疗有一定的有趣影响。
尚无明确证据表明在急性疼痛中使用阿片类药物会增加产生阿片类药物依赖的可能性。因此，烧伤后疼痛应采用药物和非药物方法积极治疗。还需进一步开展对照研究，以确定针对不同烧伤患者的合适治疗方法，并建立烧伤疼痛的标准治疗方案。
