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. 2022 Oct 12:9:997183.
doi: 10.3389/fmed.2022.997183. eCollection 2022.

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

N E E Van Loey  1   2 , A E E de Jong  3 , H W C Hofland  1 , A I M van Laarhoven  4   5
Affiliations

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

N E E Van Loey et al. Front Med (Lausanne). .

Abstract

Itch and pain are common after burns. Neuropathic mechanisms may underlie both modalities but remain not well-understood. This study aims to prospectively document neuropathic pain symptoms and to identify potential itch symptom profiles that differ regarding duration and co-occurrence with neuropathic pain which may inform underlying pathophysiological mechanisms and respond to different treatments. Adult burn survivors (n = 192) self-reported itch and neuropathic pain at 2 weeks post-discharge, 3, 6, 12, and 18 months post-burn. Based on the presence of itch and pain symptoms over time, participants were allocated to one itch profile: transient itch/pain, chronic itch, or chronic itch & pain. Profiles were compared on itch intensity over time using General Linear Modeling. Age, gender, burn severity, posttraumatic stress (PTS) symptoms and baseline itch intensity were examined as potential predictors of the profiles in a Multi-nominal regression analysis. Neuropathic pain occurred in 54% after discharge which decreased to 24% 18 months later. Itch intensity was highest in the chronic itch & pain profile. Compared to the transient itch profile, the chronic itch & pain profile was associated with higher burn severity and more PTS symptoms. Compared to the chronic itch profile, the chronic itch & pain profile was associated with more PTS symptoms. Findings suggest that biological and psycho-dermatological processes underlie both chronic neuropathic pain and itch processes in burn scars. Further research should elucidate the mechanisms underlying the different itch profiles, with specific focus on skin innervation and psychological factors.

Keywords: burns; neuropathic pain; posttraumatic stress symptoms; pruritus; scars.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Prevalence rates and observed means of itch intensity and neuropathic pain symptom intensity in complete cohort. (A) Percentage of patients indicating the symptom was present. (B) Observed means of intensity and standard deviations of the symptoms scored on a 7-point Likert scale. Bars from left to right represent the five time points from 2 weeks post discharge (T1, n = 177), 3 (T2, n = 166), 6 (T3, n = 156), 12 (T4, n = 155), and 18 (T5, n = 146) months post-burn. Blue bars relate to the total sample. Orange bars relate to the subsample experiencing neuropathic pain symptoms.
Figure 2
Figure 2
Time course of estimated means of itch intensity (ranging from 0 to 6) in the three itch profiles. N = 96 (full cases). Upper line (orange) = chronic itch & pain (n = 31), middle line (yellow) = chronic itch (n = 29), lower line (green) = transient itch/pain (n = 36). Error bars represent 1 standard deviation. T1 = 2 weeks post-discharge, T2 = 3 months post-burn, T3 = 6 months post-burn, T4 = 12 months post-burn and T5 = 18 months post-burn.
See this image and copyright information in PMC

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