Small burns are well suited for outpatient pain management, with administration of paracetamol, anti-inflammatory medications and opiates in various concentrations depending on the level of pain. The aim is to use the simplest analgesics in appropriate doses and intervals, before adding more complex analgesics.
Review the Australian & New Zealand College of Anaesthetists Acute Pain Management: Scientific Evidence for a comprehensive overview of acute pain management. An analgesia guide for the management of adult and paediatric minor burns, developed by the Pain Services at The Alfred and Royal Children’s Hospital can be found here.
The rest of this page provides a brief overview of different types of burn pain to consider and pain assessment.
Assessment is essential to guide the effective management of burns pain. The most common pain assessment tools are verbal self report instruments such as the 0 – 10 numeric rating scale.
Verbal Numerical Rating Score (VNRS)
Ask the patient to rate their pain on a linear scale of zero to ten, where zero equals no pain and ten equals the worst pain imaginable. Ask the patient to rate their pain. Aim for pain scores of 4 or less at rest
Visual Analog Scale
Visual analog, face or color scales are also used and are useful when the patient has difficulty quantifying their pain numerically.
Visit the British Pain Society website for Pain Assessment tools in different languages.
Types of Burn Pain
Background pain can be described as a continuous burning and/or throbbing sensation which is present at rest and is relatively constant. The severity of background pain varies between individuals
It is best treated with regular slow release analgesics to keep plasma drug concentrations steady such as slow release tramadol or, if more severe, a slow release morphine or equivalent.
Procedural pain is usually more intense. Mechanical stimulation of the injured site during removal of dressings, cleansing and debridement can be a major source of pain which can continue for minutes to hours after the procedure is complete. It is often described as having an intense burning or stinging sensation.
Procedural pain during the acute phase after injury can be mild to excruciating. If the dressing is expected to be painful, additional short acting analgesia 45 minutes before the dressing will ease procedural pain.