6 Pain Management
Learn how to assess changing burn pain, individualize medication and supportive care, and monitor treatment response and safety.
Assess pain repeatedly
can vary over time and with activity, so a single assessment may not capture the patient’s experience. Assess repeatedly at rest, during movement, and before, during, and after procedures.
When a patient can communicate, use rather than estimating pain from the burn’s size or appearance or relying only on facial expressions. Ask the patient to rate and describe the pain using a consistent scale. Ask about intensity and, when useful, location, quality, and effects on activity.
When self-report is not possible
If a patient cannot communicate a pain score, use an appropriate and continue to monitor. The Critical-Care Pain Observation Tool (CPOT) is one example. Do not assume that a patient has no pain because they are not speaking, and do not rely on a single sign such as heart rate to establish pain.
Assessments across different phases of care help distinguish background pain from pain associated with activity or procedures. Document pain during those phases so the care team can use the findings to guide adjustments to the plan.
Individualize the pain plan
A may combine medications with supportive techniques and should be tailored to the patient and clinical context. Treatment is individualized; depending on the patient’s condition and contraindications, the care team may combine nonopioid medications with opioids when needed and other approaches.
Medication choice and dosing require clinical judgment. No dosing regimen is specified here, and the same plan should not be assumed suitable for every patient with a similarly sized burn.
Monitor treatment and safety
Pain relief and both require attention. If a patient receiving an opioid becomes unusually drowsy, assess the patient’s condition and follow the clinical monitoring and escalation protocol before giving more medication.
Continue to monitor and respond according to the patient’s condition and local clinical protocols. Do not stop assessing pain because medication is being given or because a patient has reported pain at another time.
Add supportive techniques
Offer as adjuncts to the pain plan. Options may include distraction, such as music or a video; coaching slow breathing if the patient is willing; cognitive-behavioral techniques; or virtual reality when available.
Plan ahead for procedures and reassess pain afterward. Supportive techniques complement, rather than replace, individualized medication planning and ongoing assessment.