Report on Research Priorities for Burn Wounds Focuses on Treating Pain

Researchers have identified their top 10 priorities in the study of burn care, as part of a project on finding solutions to ongoing issues, including pain associated with burns.

The key goal of the project, led by researchers at the University of Bristol, in England, was to identify knowledge gaps in burn care that are most important to survivors, caregivers and healthcare professionals in order to guide future research and treatment improvements worldwide (Lancet Global Health 2025;13[6]:e1140-e1150).

As part of their work, researchers from Bristol Medical School polled more than 1,600 people across six continents including survivors, their families and physicians who completed a survey and attended workshops.

Burn pain is listed in the report as priority No. 4: What are the best ways to understand and reduce pain and anxiety from burn injuries and treatments, including during burn dressing changes, to improve care and support for survivors and caregivers?

Hollie Richards, BSc, MSc, the report’s lead researcher and a senior research associate at Bristol Medical School, said pain was “featured very heavily in our data, and although one priority primarily focuses on pain, it is relevant to other priorities.” For example, said Richards, long-term issues include pain, either in the form of chronic pain or related to other comorbidities resulting from a burn injury.

Richards added that pain is also a major issue in the area of burn wound dressings. “Survivors and [caregivers] told us that wound dressing changes can be incredibly painful, and more research is needed to address these issues in different situations.” For example, Richards said, some virtual reality interventions have been shown to be an effective distraction method that can reduce pain during burn dressing changes, “but this technology is not suitable or affordable for low- and middle-income country settings, where 70% of global burns occur.”

Richards said burn research is lacking, including studies on pain relief, because the work is expensive, and “the research that does take place tends to be small cohort or case studies using heterogeneous outcome measures, which prevents evidence synthesis.”

Richards added, “Pain management strategies differ regionally and globally based on many factors. In burns, it is not only the management of pain from the initial injury that is important but also pain management during treatments. This can include dressing changes and cleaning of the wounds during acute care, but also long-term treatments such as scar revision surgery or scar reduction techniques like laser treatment or steroid injections, as well as ongoing [physical therapy] and occupational therapy.” ‘A Meaningful Consensus’

Kathleen Romanowski, MD, the director of the burn care unit at University of California – Davis Health, in Sacramento, Calif., called the report innovative and insightful. Romanowski, who participated in the report’s survey and attended a workshop that finalized the research agenda, said, “What made this process particularly compelling, for me, was the realization that the concerns of clinicians often differ from those of survivors and their families. The final list reflects a meaningful consensus on the most pressing challenges in burn care today.” Romanowski said while she, personally, might have ranked burn pain higher than the fourth priority, she was pleased to see burn pain “recognized as a central concern.”

Romanowski said opioids have been the mainstay of the treatment of burn pain for many years, but recent advances “have focused on developing multimodal and personalized approaches that target the complex nature of burn-related pain.” She noted that innovations include the use of regional anesthesia techniques, such as nerve blocks and continuous catheter infusions, to reduce opioid dependence and improve pain control during and after procedures. “Nonpharmacologic therapies like virtual reality, hypnosis and cognitive behavioral interventions have also shown promise in decreasing procedural pain and anxiety,” Romanowski said. Research into novel pharmacologic agents, including N-methyl-D-aspartate receptor antagonists, gabapentinoids and cannabinoid-based therapies, offers potential for managing neuropathic and chronic burn pain, Romanowski explained.

Burn pain is difficult to treat because it is complex, intense and involves multiple types of pain simultaneously (background, procedural, breakthrough and neuropathic), Romanowski said. “Burn injuries cause both peripheral and central sensitization, which amplifies pain perception and makes even gentle stimuli painful to the burn survivor, and frequent wound care and surgical interventions further exacerbate pain.”

Altered drug metabolism in burn patients complicates medication dosing, and psychological factors such as fear and anxiety can heighten the experience of pain, Romanowski explained.

Jeffrey Shupp, MD, the director of the Burn Center at Medstar Washington Hospital Center, in Washington, D.C., said the report is invaluable and that research continues to be needed on issues regarding pain that physicians still know little about, such as the mechanisms behind neuropathic pain and itch in burn patients. There is a drastic need for novel therapies because pain in many burn patients simply goes untreated, he added.

Richards told Pain Medicine News that the research team has made all qualitative data and the preliminary thematic analysis freely available in the University of Bristol open-access data repository. She added, “We would encourage researchers and clinicians to make use of these data to explore gaps in current practice and to inform future research.”

—Francesca Krtiz