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. 2021 Oct 25;6(1):e000810.
doi: 10.1136/tsaco-2021-000810. eCollection 2021.

Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis

Christopher McGovern  1   2 , Tara Quasim  1   2 , Kathryn Puxty  1   2 , Martin Shaw  1   3 , Wijnand Ng  4 , Charlotte Gilhooly  1   2 , Nikolaos Arkoulis  5   6 , Michael Basler  7 , Alan Macfarlane  1   7 , Lia Paton  2
Affiliations

Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis

Christopher McGovern et al. Trauma Surg Acute Care Open. .

Abstract

Objectives: Pruritus is a common and often distressing complication after a burn injury. The purpose of this review is to explore the efficacy of drugs classically used to treat neuropathic pain in the management of pruritus after burn injury.

Methods: A systematic literature search of medical databases was conducted to find studies investigating drugs listed in the National Institute for Health and Care Excellence (NICE) guideline (CG173, "neuropathic pain in adults") for the management of pruritus after burn injury in patients of any age. Controlled studies were stratified by the drug class studied and their risk of bias before conducting meta-analysis. A narrative review of case series or observational studies was presented. Severity of pruritus at any time point, with all quantitative and qualitative measures, was included.

Results: Fifteen studies were included in the final analysis, 10 investigated the use of gabapentinoids, 4 studied doxepin, and 1 local anesthetic agents. Meta-analysis of three randomized controlled trials (RCTs) demonstrated that the use of gabapentinoids was associated with an improvement in mean VAS (Visual Analog Scale) 0-10 scores of 2.96 (95% confidence interval (95% CI) 1.20 to 4.73, p<0.001) when compared with placebo or antihistamine. A meta-analysis of four RCTs investigating topical doxepin showed an improvement in mean VAS scores of 1.82 (95% CI 0.55 to 3.09, p<0.001). However, when excluding two studies found to be at high risk of bias, no such improvement was found (-0.32, 95% CI -1.64 to -0.99, p=0.83).

Conclusion: This study suggests that gabapentinoids are beneficial in the management of burn-related pruritus. There is a lack of evidence to suggest that doxepin is an effective treatment. Topical local anesthetic agents may be safe and beneficial, but studies are scarce.

Level of evidence: Systematic review, level II.

Keywords: burn; patient outcome assessment.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Forest plot showing the reduction in mean VAS (Visual Analog Scale) in each treatment arm, comparing gabapentinoids with controls. 95% CI, 95% confidence interval.
Figure 2
Figure 2
Forest plot showing the reduction in mean VAS (Visual Analog Scale) in each treatment arm, comparing topical doxepin with controls. 95% CI, 95% confidence interval.
See this image and copyright information in PMC

References

    1. Barrett LW, Fear VS, Waithman JC, Wood FM, Fear MW. Understanding acute burn injury as a chronic disease. Burns Trauma 2019;7:23. 10.1186/s41038-019-0163-2 - DOI - PMC - PubMed
    1. Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, Suman OE, Mlcak RP, Herndon DN. Long-Term persistance of the pathophysiologic response to severe burn injury. PLoS One 2011;6:e21245. 10.1371/journal.pone.0021245 - DOI - PMC - PubMed
    1. O’Halloran E, Shah A, Dembo L, Hool L, Viola H, Grey C, Boyd J, O’Neill T, Wood F, Duke J, et al. . The impact of non-severe burn injury on cardiac function and long-term cardiovascular pathology. Sci Rep 2016;6:34650. 10.1038/srep34650 - DOI - PMC - PubMed
    1. Duke JM, Bauer J, Fear MW, Rea S, Wood FM, Boyd J. Burn injury, gender and cancer risk: population-based cohort study using data from Scotland and Western Australia. BMJ Open 2014;4:e003845. 10.1136/bmjopen-2013-003845 - DOI - PMC - PubMed
    1. Duke JM, Randall SM, Wood FM, Boyd JH, Fear MW. Burns and long-term infectious disease morbidity: a population-based study. Burns 2017;43:S0305-4179(16)30449-1:273–81. 10.1016/j.burns.2016.10.020 - DOI - PubMed

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