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    Burns during Infancy May Affect Later Pain and Sensory Sensitivity

    By Jennifer Huddleston, staff writer     

    Researchers in Germany have found that even moderate burns sustained during infancy can affect pain and sensory sensitivity in the long term. The findings, published in the January 2009 issue of Pain, the Journal of the International Association for the Study of Pain, are consistent with other studies suggesting that severe injuries can result in long-term variations in pain sensitivity at not only the injured site but also non-injured areas.

    Researchers conducted quantitative sensory testing for recognition and pain thresholds using thermal and mechanical stimulation techniques at two testing sites on the body, both of which were not affected by the burn injuries. The study found that pain sensitivity likely varied according to the severity of the children’s burns.

    In comparison to the control group, moderately burned children had decreased pain thresholds and increased sensitivity for mechanical pain at both sites. Severely burned children had elevated pain thresholds for heat pain at both testing sites while their sensitivity to mechanical pain was mostly unchanged. The discrepancy between the levels of sensitivity in the moderately and severely burned groups may be due in part to pain, stress and the amount of pain treatment received.

    A total of 72 children were included in the study to explore whether neonatal burn injuries are linked to long-term changes in pain and sensory processing. Twenty-four of the children in the study had sustained severe burn injuries between 6 and 24 months of age and the other 24 sustained moderate burn injuries during the same time period. All of the moderately and severely burned children studied had been admitted to the pediatric burn centers at the University Hospital in Mannheim, Germany. Another 24 children were recruited as part of the control group.

    The classification as either “moderate” or “severe” was not determined by the amount of pain or stress suffered by the children, but rather by the degree of the burns sustained. The severely burned group had a greater body surface area affected by the burns and had been hospitalized for longer than the group with moderate burns. A greater amount of severely burned children also had received intensive care treatment, had to be ventilated and had undergone surgeries. While all children with severe burns were given pain relievers, half of the moderately burned group received no analgesics. Further, fewer children with moderate burns had received sedatives compared to the children with severe burns.

    While moderately burned children endured a relatively short period of intense pain during the one to three weeks it took for their burns to heal, they were provided inadequate pain treatment during that time. In contrast, the severely burned children endured pain on a daily basis for a longer period of time and underwent multiple procedures (two-thirds of the group underwent skin grafting), but also received greater pain treatment. However, it is not known if the pain treatments received by the severely burned group eliminated or even significantly reduced their pain.

    All of the children in the study also completed questionnaires to assess their emotional well being, and the mothers of the children completed similar questionnaires regarding their offspring. These questionnaires revealed that while the moderately burned children had scores similar to the children in the control group, the children in the severely burned group were significantly more anxious and reported considerably greater dysphoria as well as more exhaustion and bodily complaints than the control children. The mothers of the children in the severely burned group also reported significantly more behavioral problems than those with children in the control group.

    According to the researchers, previous animal studies have shown that stress during infancy, whether or not related to pain, can lead to changes in pain sensitivity later in life. This is important to note given the fact that severely burned children are likely to have experienced significant stress and anxiety stemming from separation from their parents for extended periods of time and repeated painful procedures, among other factors.

    This study did not delve into the relationship between the sustained injuries and the insufficient treatment of pain associated with those injuries. Larger-scale studies are needed to assess this correlation and other unanswered questions relating to changed pain sensitivity and the risk for pain problems in adulthood.

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