TY - JOUR
T1 - Chronic Neuropathic Pain Following Hand Burns
T2 - Etiology, Treatment, and Long-Term Outcomes
AU - Klifto, Kevin M.
AU - Yesantharao, Pooja S.
AU - Dellon, A. Lee
AU - Hultman, C. Scott
AU - Lifchez, Scott D.
N1 - Funding Information:
We thank Carrie Cox, MS, RN, and Vidhi Javia, BS, for assistance with coordinating clinical research at The Johns Hopkins Burn Center. Without their assistance our work would not be possible.
Publisher Copyright:
© 2021 American Society for Surgery of the Hand
PY - 2021/1
Y1 - 2021/1
N2 - Purpose: Chronic neuropathic pain (CNP) after burn injury to the hand/upper extremity is relatively common, but not well described in the literature. This study characterizes patients with CNP after hand/upper extremity burns to help guide risk stratification and treatment strategies. We hypothesize that multiple risk factors contribute to the development of CNP and refractory responses to treatment. Methods: Patients older than 15 years admitted to the burn center after hand/upper extremity burns, from January 1, 2014, through January 1, 2019, were included. Chronic neuropathic pain was defined as self-described pain for longer than 6 months after burn injury, not including pain due to preexisting illness/medications. Two analyses were undertaken: (1) determining risk factors for developing CNP among patients with hand/upper extremity burns, and (2) determining risk factors for developing refractory pain (ie, nonresponsive to treatment) among hand/upper extremity burn patients with CNP. Results: Of the 914 patients who met the inclusion criteria, 55 (6%) developed CNP after hand/upper extremity burns. Twenty-nine of these patients (53%) had refractory CNP. Significant risk factors for developing CNP after hand/upper extremity burns included history of substance abuse and tobacco use. Among CNP patients, significant risk factors for developing refractory pain included symptoms of burning sensations. In all CNP patients, gabapentin and ascorbic acid were associated with significant decreases in pain scores on follow-up. Conclusions: Substance abuse and tobacco use may contribute to the development of CNP after hand/upper extremity burns. Those who developed refractory CNP were more likely to use the pain descriptor, burning sensations. Pharmacological pain management with gabapentin or pregabalin and ascorbic acid may provide the most relief of CNP symptoms. Type of study/level of evidence: Therapeutic IV.
AB - Purpose: Chronic neuropathic pain (CNP) after burn injury to the hand/upper extremity is relatively common, but not well described in the literature. This study characterizes patients with CNP after hand/upper extremity burns to help guide risk stratification and treatment strategies. We hypothesize that multiple risk factors contribute to the development of CNP and refractory responses to treatment. Methods: Patients older than 15 years admitted to the burn center after hand/upper extremity burns, from January 1, 2014, through January 1, 2019, were included. Chronic neuropathic pain was defined as self-described pain for longer than 6 months after burn injury, not including pain due to preexisting illness/medications. Two analyses were undertaken: (1) determining risk factors for developing CNP among patients with hand/upper extremity burns, and (2) determining risk factors for developing refractory pain (ie, nonresponsive to treatment) among hand/upper extremity burn patients with CNP. Results: Of the 914 patients who met the inclusion criteria, 55 (6%) developed CNP after hand/upper extremity burns. Twenty-nine of these patients (53%) had refractory CNP. Significant risk factors for developing CNP after hand/upper extremity burns included history of substance abuse and tobacco use. Among CNP patients, significant risk factors for developing refractory pain included symptoms of burning sensations. In all CNP patients, gabapentin and ascorbic acid were associated with significant decreases in pain scores on follow-up. Conclusions: Substance abuse and tobacco use may contribute to the development of CNP after hand/upper extremity burns. Those who developed refractory CNP were more likely to use the pain descriptor, burning sensations. Pharmacological pain management with gabapentin or pregabalin and ascorbic acid may provide the most relief of CNP symptoms. Type of study/level of evidence: Therapeutic IV.
KW - Ascorbic acid
KW - burn
KW - chronic pain
KW - gabapentin
KW - hand
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U2 - 10.1016/j.jhsa.2020.07.001
DO - 10.1016/j.jhsa.2020.07.001
M3 - Article
C2 - 32855013
AN - SCOPUS:85089826369
SN - 0363-5023
VL - 46
SP - 67.e1-67.e9
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 1
ER -