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Three Part Question

[In patients with partial thickness burns] are [non-opioid analgesics] effective at [controlling pain]?

Clinical Scenario

A 24 year old male car mechanic is brought to the surgery after burning his hand on a hot car exhaust. After finding this to be a partial thickness burn and acutely dealing with the burnt area, you telephone the local injuries unit to inquire as to the most effective non-opioid analgesic he can be given so that he can safely return to work.

Search Strategy

Medline 1966- week 3 09/04 using the Ovid interface
[exp burns OR exp skin OR thermal burns.mp] AND [exp analgesics OR exp analgesics, non-narcotic] LIMIT to human, English AND RCT

Search Outcome

Altogether 157 papers were found of which 155 were irrelevant or of insufficient quality. The remaining two papers are shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Petersen KL et al, 1997, Denmark	20 male volunteers. Induced burn injury on calf. Pain stimulation by pinprick, stroke or motor brush. Tested using Ibuprofen 600mgs or placebo, before and at 2, 3, and 4hrs after medication	Double blind crossover study	Electronic visual analogue scale(VAS)	Ibuprofen significantly reduces secondary hyperalgesia by brush stimulation secondary to burn pain but not by pinprick or stroke. Peak effects at 2-3 hrs. Ibuprofen did not reduce pain evoked by burn injury alone.	First degree burns only
Bickel A et al, 1998, Germany	21 male volunteers. Induced intense UVB-irradiation, then 24hrs later hyperalgesia (both thermal and mechanical).	Double-blind cross over study	Oral sensory rating	Ibuprofen 600mgs significantly reduced UVB burn pain and elevated pain threshold compared to placebo.	First degree burns

Comment(s)

There is a paucity of information regarding non-opioid analgesia for partial thickness burns. In these two similar double blind randomised cross over studies of induced burns followed by later hyperalgesia, Ibuprofen significantly elevated the pain threshold level compared with placebo. However in one study Ibuprofen did not reduce the pain evoked by the burn alone. No suitable trials using Paracetamol or other NSAIDs were found.

Clinical Bottom Line

Ibuprofen 600mgs. does reduce secondary pain following partial thickness burn pain, but there is conflicting evidence as to whether it reduces the pain of the burn alone. There is no available evidence regarding other non-opioid analgesics.

References

1. Petersen KL, Brennum J, Dahl JB. Experimental evaluation of the analgesic effect of ibuprofen on primary and secondary hyperalgesia Pain 1997;70(2-3):167-174.
2. Bickel A, Dorfs S, Schmelz M, et al. Effects of antihyperalgesic drugs on experimentally induced hyperalgesia in man. Pain 1998;76(3):317-325.