Early opioid use in acute severe burn injuries and long-term pain and quality of life

Introduction

Pain management in the intensive care unit (ICU) following severe burn injury, particularly the use of high dose opioid therapy, may contribute to the development of long-term pain and impact long term health-related quality of life. This study aims to describe the analgesic management and long-term self-rated health-related quality of life, including functional, psychological and pain outcomes, in patients admitted to ICU with a major burn injury.

Methods

This was a retrospective analysis of prospectively collected data. All patients who were admitted to a tertiary referral intensive care unit with burns ≥20 % of total body surface area (TBSA) and survived to hospital discharge were included. Data relating to the severity of injury and analgesia management were collected for each patient. Patients completed follow up with the EQ-5D-5L questionnaire at 6- and 12-months post burn injury.

Results

84 patients were included. Seventy eight percent of patients reported long term issues with pain at 12 month follow up. Seventy-four percent of patients reported issues at 12 months with usual activities and 78 % reported issues with anxiety and depression. The mean dose of opioids (oral morphine equivalent dosing) prescribed to patients who reported issues with pain was not significantly different to those who did not report issues with pain at long term follow up (5079 (SD 7006) mg vs 3599 (SD 3175) mg, p = 0.2).

Conclusions

Patients who suffer major burns requiring ICU admission have long term issues with pain/discomfort, mobility, usual activities, self-care, and anxiety and depression, that are greater than reported in the general burns population. The total dose of opioids given in the acute stage of injury do not seem to influence the prevalence of long-term pain/discomforts in burn patients.