Clinics in plastic surgery
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This article describes pathophysiology of burn injury-related pain and the basic principles of burn pain management. The focus is on concepts of perioperative and periprocedural pain management with extensive discussion of opioid-based analgesia, including patient-controlled analgesia, challenges of effective opioid therapy in opioid-tolerant patients, and opioid-induced hyperalgesia. The principles of multimodal pain management are discussed, including the importance of psychological counseling, perioperative interventional pain procedures, and alternative pain management options. A brief synopsis of the principles of outpatient pain management is provided.
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The objective of this systematic review was to assess the effectiveness of laser therapy for the treatment of hypertrophic burn scars. Improvements in scar symptoms following laser treatment were reported in 11 of the 12 included studies. ⋯ As a result, there is insufficient scientific evidence to determine the effectiveness of laser therapy from this systematic review. Future studies that use more rigorous study designs such as randomized controlled trials are needed to support the use of laser therapy for hypertrophic burn scars.
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Peripheral neuropathy and nerve compression syndromes lead to substantial morbidity following burn injury. Patients present with pain, paresthesias, or weakness along a specific nerve distribution or experience generalized peripheral neuropathy. ⋯ Peripheral neuropathy may be caused by vascular occlusion of vasa nervorum, inflammation, neurotoxin production leading to apoptosis, and direct destruction of nerves from the burn injury. This article discusses the natural history, diagnosis, current treatments, and future directions for potential interventions for peripheral neuropathy and nerve compression syndromes related to burn injury.