Management of Procedural Pain in Pediatric Burnt Patients: A Review


  • Haitham ELsayed Elsadek Alzahra Hospital Dubai, Sheikh Zayed Rd, Al Barsha & Dubai Health Authority, Headquarters, Sheikh Ahmed Square, Al Jaddaf, Dubai, United Arab Emirates



Analgesics, Aromatherapy, Anxiety, Burn injury, Benzodiazepines, Hypnosis, Ketamine, Opioids, Pediatrics, Pain Management, Procedural pain, Pain perception, Propofol, Sedation, Total Body Surface Area, Visual Analog Scale


Burn injuries are the sixth leading cause of mortality globally and among the top five causes of injury in pediatrics. Therefore, this study aimed to review the methods and treatments for managing procedural pain in pediatric burnt patients, focusing on alleviating burning sensations effectively. Data were gathered from various electronic databases spanning 2015 to 2024 using keywords related to pain management, burn injuries, and intervention strategies. Utilizing frameworks like SPIDER, PICO, and ROBIS, 85 articles were selected for review, elucidating interventions, pain assessment criteria, and management guidelines. The review underscores the progress in effective therapies while aiming to determine the prevalence and treatment of procedural burn pain in pediatrics. Further, it encompasses treatment criteria, protocols, pharmacological and non-pharmacological interventions, and lifestyle modifications. This indicates that effective treatment options are progressing. This review concluded personalized, multimodal pain treatment methods for enhancing the health and efficiency of patients in vulnerable situations.


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Ahuja, R. B., Gibran, N., Greenhalgh, D., Jeng, J., Mackie, D., Moghazy, A., Moiemen, N., Palmieri, T., Peck, M., & Serghiou, M. (2016). ISBI practice guidelines for burn care. Burns, 42(5), 953-1021.

Ali, N. S. (2015). Critical Care Nurses’ Application of non pharmacological Pain Management Approaches at Cairo University Hospitals. Egyptian Journal of Nursing, 10(1).

Altenmüller, E., & Ioannou, C. I. (2016). Music performance: expectations, failures, and prevention. In Performance Psychology (pp. 103-119). Elsevier.

Anderson, T. A., & Fuzaylov, G. (2014). Perioperative anesthesia management of the burn patient. Surgical Clinics, 94(4), 851-861.

Ayik, C., & Özden, D. (2018). The effects of preoperative aromatherapy massage on anxiety and sleep quality of colorectal surgery patients: A randomized controlled study. Complementary therapies in medicine, 36, 93-99.

Baarslag, M. A., Allegaert, K., Knibbe, C. A., van Dijk, M., & Tibboel, D. (2017). Pharmacological sedation management in the paediatric intensive care unit. Journal of Pharmacy and Pharmacology, 69(5), 498-513.

Babl, F. E., Crellin, D., Cheng, J., Sullivan, T. P., O’Sullivan, R., & Hutchinson, A. (2012). The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. Pediatric Emergency Care, 28(12), 1281-1296.

Brekke, R. L., Almeland, S. K., Hufthammer, K. O., & Hansson, E. (2023). Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review. Burns, 49(3), 493-515.

Burgess, M., Valdera, F., Varon, D., Kankuri, E., & Nuutila, K. (2022). The immune and regenerative response to burn injury. Cells, 11(19), 3073.

Carey, M. G., Valcin, E. K., Lent, D., & White, M. (2021). Nursing care for the initial resuscitation of burn patients. Critical Care Nursing Clinics, 33(3), 275-285.

Carrougher, G. J., Burton-Williams, K., Gauthier, K., Gloger, A., Remington, L., & Yukon, K. (2020). Burn nurse competency utilization: report from the 2019 Annual American Burn Association Meeting. Journal of Burn Care & Research, 41(1), 41-47.

Cartotto, R., Burmeister, D. M., & Kubasiak, J. C. (2022). Burn shock and resuscitation: review and state of the science. Journal of Burn Care & Research, 43(3), 567-585.

Cettler, M., Zielińska, M., Rosada-Kurasińska, J., Kubica-Cielińska, A., Jarosz, K., & Bartkowska-Śniatkowska, A. (2022). Guidelines for treatment of acute pain in children–the consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy. Anaesthesiology Intensive Therapy, 54(3), 197-218.

Chester, S. J., Stockton, K., De Young, A., Kipping, B., Tyack, Z., Griffin, B., Chester, R. L., & Kimble, R. M. (2016). Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial. Trials, 17(1), 1-11.

Chester, S. J., Tyack, Z., De Young, A., Kipping, B., Griffin, B., Stockton, K., Ware, R. S., Zhang, X., & Kimble, R. M. (2018). Efficacy of hypnosis on pain, wound-healing, anxiety, and stress in children with acute burn injuries: a randomized controlled trial. Pain, 159(9), 1790-1801.

Claudio, P., & Maddalena, P. (2014). Overview: Virtual reality in medicine. Journal of Virtual Worlds Research, 7(1).

Cohen, L. L., Donati, M. R., Shih, S., & Sil, S. (2020). Topical review: State of the field of child self-report of acute pain. Journal of Pediatric Psychology, 45(3), 239-246.

Dezfouli, S. M. M., & Khosravi, S. (2020). Systematic review of the effective factors in pain management in children. Pakistan Journal of Medical & Health Sciences, 14(2), 1236-1243.

Dries, D. J., & Marini, J. J. (2017). Management of critical burn injuries: recent developments. Korean Journal of Critical Care Medicine, 32(1), 9-21.

Drummond, S., Ackerman, R. S., & Somasundaram, A. (2020). Pain Assessment and Treatment for the Trauma and Burn Patient. Pain Management for Clinicians: A Guide to Assessment and Treatment, 3-30.

Eijlers, R., Utens, E. M., Staals, L. M., de Nijs, P. F., Berghmans, J. M., Wijnen, R. M., Hillegers, M. H., Dierckx, B., & Legerstee, J. S. (2019). Meta-analysis: systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety. Anesthesia and analgesia, 129(5), 1344.

Fagin, A., & Palmieri, T. L. (2017). Considerations for pediatric burn sedation and analgesia. Burns & trauma, 5.

Fardin, A., Rezaei, S. A., & Maslakpak, M. H. (2020). Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials. Complementary therapies in medicine, 49, 102341.

Farzan, R., Parvizi, A., Haddadi, S., Sadeh Tabarian, M., Jamshidbeigi, A., Samidoust, P., Ghorbani Vajargah, P., Mollaei, A., Takasi, P., & Karkhah, S. (2023). Effects of non‐pharmacological interventions on pain intensity of children with burns: a systematic review and meta‐analysis. International Wound Journal.

Feng, Z., Tang, Q., Lin, J., He, Q., & Peng, C. (2018). Application of animated cartoons in reducing the pain of dressing changes in children with burn injuries. International journal of burns and trauma, 8(5), 106.

Feng, Z., Tang, Q., Lin, J., He, Q., & Peng, C. (2018). Application of animated cartoons in reducing the pain of dressing changes in children with burn injuries. Int J Burns Trauma, 8(5), 106-113.

Foster, K. (2014). Clinical guidelines in the management of burn injury: a review and recommendations from the organization and delivery of burn care committee. Journal of Burn Care & Research, 35(4), 271-283.

Fuzaylov, G. (2020). Anesthesia for Burns. Gregory’s Pediatric Anesthesia, 996-1011.

Gasibat, Q., & Suwehli, W. (2017). Determining the benefits of massage mechanisms: a review of literature. Rehabilitation Sciences, 3(2), 58-67.

Geagea, D., Griffin, B., Kimble, R., Polito, V., Terhune, D. B., & Tyack, Z. (2022). Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol. Pilot and Feasibility Studies, 8(1), 58.

Giretzlehner, M., Ganitzer, I., & Haller, H. (2021). Technical and medical aspects of burn size assessment and documentation. Medicina, 57(3), 242.

Gosnell, E. S., & Thikkurissy, S. (2019). Assessment and management of pain in the pediatric patient. In Pediatric Dentistry (pp. 97-115. e111). Elsevier.

Grossmann, B., Nilsson, A., Sjöberg, F., & Nilsson, L. (2019). Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study. Burns, 45(5), 1081-1088.

Helander, E. M., Menard, B. L., Harmon, C. M., Homra, B. K., Allain, A. V., Bordelon, G. J., Wyche, M. Q., Padnos, I. W., Lavrova, A., & Kaye, A. D. (2017). Multimodal analgesia, current concepts, and acute pain considerations. Current pain and headache reports, 21, 1-10.

Ismail, A., Forgeron, P., Polomeno, V., Gharaibeh, H., Dagg, W., & Harrison, D. (2019). Pain management interventions in the paediatric intensive care unit: a scoping review. Intensive and Critical Care Nursing, 54, 96-105.

Jaaniste, T., Noel, M., Yee, R. D., Bang, J., Tan, A. C., & Champion, G. D. (2019). Why unidimensional pain measurement prevails in the pediatric acute pain context and what multidimensional self-report methods can offer. Children, 6(12), 132.

Jeschke, M. G., van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S., & Logsetty, S. (2020). Burn injury. Nature Reviews Disease Primers, 6(1), 11.

Kaddoura, I., Abu-Sittah, G., Ibrahim, A., Karamanoukian, R., & Papazian, N. (2017). Burn injury: review of pathophysiology and therapeutic modalities in major burns. Annals of burns and Fire Disasters, 30(2), 95.

Kazis, L. E., Sheridan, R. L., Shapiro, G. D., Lee, A. F., Liang, M. H., Ryan, C. M., Schneider, J. C., Lydon, M., Soley-Bori, M., Sonis, L. A., Dore, E. C., Palmieri, T., Herndon, D., Meyer, W., Warner, P., Kagan, R., Stoddard, F. J., Murphy, M., & Tompkins, R. G. (2018). Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns. Journal of Trauma and Acute Care Surgery, 84(4).

Kudchadkar, S. R., Berger, J., Patel, R., Barnes, S., Twose, C., Walker, T., Mitchell, R., Song, J., Anton, B., & Punjabi, N. M. (2022). Non‐pharmacological interventions for sleep promotion in hospitalized children. Cochrane database of systematic reviews(6).

Laures, E., LaFond, C., Hanrahan, K., Pierce, N., Min, H., & McCarthy, A. M. (2019). Pain assessment practices in the pediatric intensive care unit. Journal of pediatric nursing, 48, 55-62.

Lee, G. I., & Neumeister, M. W. (2020). Pain: pathways and physiology. Clinics in plastic surgery, 47(2), 173-180.

Lundeberg, S., & Lundeberg, T. (2013). Pain in infants and children—Physiological background and clinical aspects. Acupuncture and related Therapies, 1(4), 46-49.

McPherson, C., & Grunau, R. E. (2022). Pharmacologic analgesia and sedation in neonates. Clinics in Perinatology, 49(1), 243-265.

Meyer III, W. J., Martyn, J. J., Wiechman, S., Thomas, C. R., & Woodson, L. (2018). Management of pain and other discomforts in burned patients. In Total burn care (pp. 679-699. e676). Elsevier.

Meyer, W. J., Jeevendra Martyn, J. A., Wiechman, S., Thomas, C. R., & Woodson, L. (2018). 64 - Management of Pain and Other Discomforts in Burned Patients. In D. N. Herndon (Ed.), Total Burn Care (Fifth Edition) (pp. 679-699.e676). Elsevier.

Milling, L. S., Valentine, K. E., LoStimolo, L. M., Nett, A. M., & McCarley, H. S. (2021). Hypnosis and the alleviation of clinical pain: a comprehensive meta-analysis. International Journal of Clinical and Experimental Hypnosis, 69(3), 297-322.

Minardi, C., Sahillioglu, E., Astuto, M., Colombo, M., & Mauricio Ingelmo, P. (2012). Sedation and analgesia in pediatric intensive care. Current drug targets, 13(7), 936-943.

Miri, S., Hosseini, S. J., Ghorbani Vajargah, P., Firooz, M., Takasi, P., Mollaei, A., Ramezani, S., Tolouei, M., Emami Zeydi, A., & Osuji, J. (2023). Effects of massage therapy on pain and anxiety intensity in patients with burns: a systematic review and meta‐analysis. International Wound Journal.

Mobilizations, J. (2015). Massage Techniques. Massage Therapy: Principles and Practice, 136.

Mofredj, A., Alaya, S., Tassaioust, K., Bahloul, H., & Mrabet, A. (2016). Music therapy, a review of the potential therapeutic benefits for the critically ill. Journal of critical care, 35, 195-199.

Najafi Ghezeljeh, T., Mohades Ardebili, F., & Rafii, F. (2017). The effects of massage and music on pain, anxiety and relaxation in burn patients: Randomized controlled clinical trial. Burns, 43(5), 1034-1043.

Nosanov, L. B., Brandt, J. L., Schneider, D. M., & Johnson, L. S. (2020). Pain management in burn patients. Current Trauma Reports, 6, 161-173.

Pancekauskaitė, G., & Jankauskaitė, L. (2018). Paediatric pain medicine: pain differences, recognition and coping acute procedural pain in paediatric emergency room. Medicina, 54(6), 94.

Pietsch, U., Fischer, H., Rüst, C. A., Hossfeld, B., Grünenfelder, A., Wenzel, V., & Albrecht, R. (2023). Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine, 31(1), 1-6.

Preston, D., & Ambardekar, A. (2020). The pediatric burn: current trends and future directions. Anesthesiology Clinics, 38(3), 517-530.

Provençal, S.-C., Bond, S., Rizkallah, E., & El-Baalbaki, G. (2018). Hypnosis for burn wound care pain and anxiety: A systematic review and meta-analysis. Burns, 44(8), 1870-1881.

Pruskowski, K. A., Gurney, J. M., & Cancio, L. C. (2020). Impact of the implementation of a therapy dog program on burn center patients and staff. Burns, 46(2), 293-297.

Qureshi, M. A., Lalwani, P., Asad, I., Khan-Assad, N., Mohamedali, S., Otour, B., Chaudhary, A., & Mendonca, D. (2021). Single stage first layer biosynthetic cellulose dressing versus non-adherent gauze management in paediatric burns. Burns Open, 5(4), 17-23.

Rafii, F., Ameri, F., Haghani, H., & Ghobadi, A. (2020). The effect of aromatherapy massage with lavender and chamomile oil on anxiety and sleep quality of patients with burns. Burns, 46(1), 164-171.

Rajarajan, J. (2015). Clinico-Pathological Correlation and Assessment of Burn Wounds Thanjavur Medical College, Thanjavur].

Ramachandran, M., Durairaj, A. R., Mahipathy, S. R. R. V., & Sundaramurthy, N. (2017). Analysis of psychiatric problems in burn patients in a tertiary burn unit: a prospective study. International Surgery Journal, 4(12), 4015-4021.

Rice, P. L., & Orgill, D. (2021). Assessment and classification of burn injury. UpToDate,[Internet], 8.

Rowan, M. P., Cancio, L. C., Elster, E. A., Burmeister, D. M., Rose, L. F., Natesan, S., Chan, R. K., Christy, R. J., & Chung, K. K. (2015). Burn wound healing and treatment: review and advancements. Critical care, 19, 1-12.

Saeman, M. R., Hodgman, E. I., Burris, A., Wolf, S. E., Arnoldo, B. D., Kowalske, K. J., & Phelan, H. A. (2016). Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital. Burns, 42(1), 202-208.

Santiago, V. H. V., Bustamante, V. G., Fernández, E. D. J. R., & Espíndola, R. R. (2020). Physiological mechanisms of the development of pain in burn.

Scheffler, M., Koranyi, S., Meissner, W., Strauß, B., & Rosendahl, J. (2018). Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: A systematic review and meta-analysis of randomized controlled trials. Burns, 44(7), 1709-1720.

Scheffler, M., Koranyi, S., Meissner, W., Strauss, B., & Rosendahl, J. (2018). Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: a systematic review and meta-analysis of randomized controlled trials. Burns, 44(7), 1709-1720.

Seyyed-Rasooli, A., Salehi, F., Mohammadpoorasl, A., Goljaryan, S., Seyyedi, Z., & Thomson, B. (2016). Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial. Burns, 42(8), 1774-1780.

Shank, E. S., Coté, C. J., & Martyn, J. J. (2019). Burn injuries. In A Practice of Anesthesia for Infants and Children (pp. 820-839. e811). Elsevier.

Shiferaw, A., Mola, S., Gashaw, A., & Sintayehu, A. (2022a). Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures. Annals of Medicine and Surgery, 83, 104756.

Shiferaw, A., Mola, S., Gashaw, A., & Sintayehu, A. (2022b). Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures. Annals of Medicine and Surgery, 104756.

Shimoji, K., & Aida, S. (2021). Pain measurements. Chronic Pain Management in General and Hospital Practice, 173-200.

Sine, R. M. (2019). Therapeutic Pain Management: Nursing Care for Patients Suffering from Burns.

Stapelberg, F. (2020). Challenges in anaesthesia and pain management for burn injuries. Anaesthesia and Intensive Care, 48(2), 101-113.

Tocco-Tussardi, I., Presman, B., & Huss, F. (2018). Want correct percentage of TBSA burned? Let a layman do the assessment. Journal of Burn Care & Research, 39(2), 295-301.

Unseld, M., Zeilinger, E. L., Fellinger, M., Lubowitzki, S., Krammer, K., Nader, I. W., Hafner, M., Kitta, A., Adamidis, F., & Masel, E. K. (2021). Prevalence of pain and its association with symptoms of post‐traumatic stress disorder, depression, anxiety and distress in 846 cancer patients: A cross sectional study. Psycho‐Oncology, 30(4), 504-510.

van der Heijden, M. J., Jeekel, J., Rode, H., Cox, S., van Rosmalen, J., Hunink, M. G., & van Dijk, M. (2018). Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial. Burns, 44(4), 823-833.

Van Ryckeghem, D. M., Van Damme, S., Eccleston, C., & Crombez, G. (2018). The efficacy of attentional distraction and sensory monitoring in chronic pain patients: a meta-analysis. Clinical Psychology Review, 59, 16-29.

Whiting, P., Savović, J., Higgins, J. P., Caldwell, D. M., Reeves, B. C., Shea, B., Davies, P., Kleijnen, J., & Churchill, R. (2016). ROBIS: a new tool to assess risk of bias in systematic reviews was developed. Journal of clinical epidemiology, 69, 225-234.

Wiechman, S. A. (2020). Long-Term Outcomes Following Burn Injuries. Handbook of Burns Volume 2: Reconstruction and Rehabilitation, 15-23.

Woodson, L. C., Sherwood, E. R., Kinsky, M. P., Talon, M., Martinello, C., & Woodson, S. M. (2018). Anesthesia for burned patients. In Total burn care (pp. 131-157. e134). Elsevier.

Yang, C., Xu, X.-m., & He, G.-z. (2018). Efficacy and feasibility of opioids for burn analgesia: an evidence-based qualitative review of randomized controlled trials. Burns, 44(2), 241-248.

Yastı, A. Ç., Şenel, E., Saydam, M., Özok, G., Çoruh, A., & Yorgancı, K. (2015). Guideline and treatment algorithm for burn injuries.

Żwierełło, W., Piorun, K., Skórka-Majewicz, M., Maruszewska, A., Antoniewski, J., & Gutowska, I. (2023). Burns: classification, pathophysiology, and treatment: a review. International Journal of Molecular Sciences, 24(4), 3749.




How to Cite

Elsadek, H. E. (2024). Management of Procedural Pain in Pediatric Burnt Patients: A Review. American Journal of Medical Science and Innovation, 3(1), 51–61.