Chronic Nerve Pain After Burn Injury: An Anatomic Approach to Independent Risk Factors
Kevin M. Klifto, PharmD1, Pooja S. Yesantharao, MS2, A. Lee Dellon, MD, PhD3 and C. Scott Hultman, MD, MBA2, (1)University of Pennsylvania, Philadelphia, PA, (2)Johns Hopkins University School of Medicine, Baltimore, MD, (3)Plastic Surgery, Johns Hopkins University, Baltimore, MD
Background: Burn-related nerve pain (BRNP) can cause significant long-term morbidity. This study characterized patients with burns involving different anatomical locations of the body to determine anatomic-specific risk factors independently associated with developing BRNP.
Methods: Patients ≥15 years admitted to the Burn Center were included from January 2014 to January 2019. BRNP was defined as symptomatic pain for ≥6 months after burn injury, unrelated to pre-existing illness/medications. Comparisons were made for all 11 anatomic-specific locations between BRNP and no BRNP patients using univariate followed by multivariate analyses.
Results: Of the 1862 patients with anatomical data, the prevalence's of BRNP were calculated from 113 patients. The following factors were independently associated with increased odds of BRNP. Hand burns: substance abuse [OR:10.1,p=0.008], tobacco use [OR:31.0,p<0.001], intubation [OR:7.5,p=0.02], hospital length-of-stay (LOS) [OR:1.1,p=0.01], and burn surgery [OR:4.3,p=0.04]. Forearm burns: older age [OR:1.1,p=0.03], substance abuse [OR:9.9,p=0.02], tobacco use [OR:16.6,p<0.001], intubation [OR:7.2,p=0.02], percent total body surface area burned (%TBSA)[OR:1.1,p=0.03], and burn surgery [OR:7.6,p=0.002]. Upper arm burns: substance abuse [OR:6.2,p=0.02], tobacco use [OR:8.7,p<0.001], intubation [OR:4.7,p=0.02], and burn surgery [OR:5.7,p=0.002]. Thigh burns: substance abuse [OR:8.2,p=0.04] and tobacco use [OR:19.4,p<0.001]. Foot burns: hospital LOS [OR:1.2,p=0.02] and tobacco use [OR:35.5,p=0.01]. Neck burns: older age [OR:1.4,p=0.03] and substance abuse [OR:10.4,p=0.04]. Median follow-up was 26 months (range:8-55).
Conclusions: This study identified risk factors independently associated with developing BRNP at 11 anatomic locations to better tailor preventative efforts. Burns that involved the forearm, upper arm, chest/abdomen, thigh, and lower leg had the highest rates of developing BRNP.
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