All burns are painful and superficial partial-thickness burns are most painful. Burn injury not only makes an injured area and surrounding tissue more painful but also causes hyperalgesia, chiefly due to the A fibers. Pain management should not be neglected.
During the emergency phase, the preferred route for most medication is intravenous, because of the potential problems with absorption from the muscle and gastrointestinal tract related to decreased perfusion. Morphine is the most widely used drug for relief of pain, and relatively large doses may be required. Anxiolytic agents should be used as adjuvants in pain management.
During the acute phase and for ambulatory patients treated in the ED, narcotic analgesics are required for procedural pain. Oral analgesics like codeine, hydrocodone, oxycodone, or nonsteroidal anti-inflammatory drugs may be used for the background pain.
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