During winter, with many of us warming up beside heaters and fires,can be really cosy as long as it doesn't result in burns. There are many causes of burns, including fire, chemicals, electricity, hot liquids and steam.
There are more than 5,800 hospitalised burns cases in Australia each year and 20 per cent of these are life threatening.
Pain from burns can be severe. In most cases, the burn should be swamped with cold tap water to stop the burning and reduce the pain. If it is a large or deep burn, the loss of fluid can cause hypothermia, so heat loss from the body needs to be prevented. Generally, the expression, 'cool the burn, warm the patient' is useful to apply.
A novel dressing aid has also been associated with pain reduction: honey has a pain- reducing effect, as well as limiting partial- thickness burns from converting to full- thickness burns, and promoting healing.
The skin is our largest organ and burns can damage it to different depths in a single encounter, so a single burn could have all of the following characteristics:
- First-degree: affects only the outer layer of the skin (epidermis). It causes redness and usually heals within a week, e.g. sunburn.
- Second-degree: affects the outer and second layer of skin (dermis), causing swelling. This burn can look watery or moist. Blisters may develop and pain can be severe.
- Third-degree: penetrates into the fat layer. The burn area can look taut, waxy or leathery. These burns can destroy nerves, causing numbness.
- Fourth-degree: the most severe, damaging other tissues, such as muscle and bone. Skin may appear blackened.
Emergency medical assistance will be needed for third- and fourth-degree burns and doctors may need to operate or undertake other procedures. Following the initial injury, there is a massive stimulation of the nerve endings in the damaged skin, which is painful, regardless of burn depth.
There will be different analgesia for background pain and procedural pain, e.g. dressing changes. Oral, longer-acting opioids and anti-steroidal anti- inflammatory drugs are commonly used to control background pain.
There are a range of medical options to control procedural pain, which will be tailored to individual patients' needs and tolerances, including opioids, epidural injections, nerve blocks, topical and subcutaneous local anaesthetics, inhaled anaesthetics or general anaesthesia.
Dressings such as synthetic skin substitutes can be used on wounds until healthy skin has formed, thus reducing the pain of dressing changes and the risk of infection.
In addition to medication, other techniques can be employed for pain relief during dressing changes, such as hypnosis, massage, virtual-reality helmets, and parental nurturing for children.
Physiotherapists and occupational therapists are central to burns patients' rehabilitation. The body part must be mobilised to lengthen tendons and muscle groups. The range of motion exercises involving all affected joints are needed daily to avoid contractures from developing. These exercises need to be performed humanely, without undue pain and anxiety. For many burns patients, rehabilitation will continue as an outpatient and may last for a year or two.
Persistent pain & itching
A study in the USA of people with burning to an average of 59 per cent of their bodies complained of persistent pain 12 years later, severe enough to interfere with their daily lives.
Damaged nerves may lead to neuropathic pain, interrupting sleep and resulting in depression. Hyperalgesia (increased response to a painful stimulus) and allodynia (a painful response to a non-painful stimulus) may persist into the future. Extreme itching (pruritis) is a common part of wound healing but lessens with wound recovery.
The management of severe burns has come a long way. A decade ago, the goal was survival; now it extends to reintegration back into school, work and communities.