Multimodal pain management in acute and chronic burn care: from acute injury to long-term recovery

Background. Pain associated with burn injury is severe, multifactorial, and dynamic, evolving from acute nociceptive and procedural pain to chronic neuropathic and nociplastic pain states. Inadequate pain control contributes to delayed rehabilitation, psychological morbidity, prolonged opioid use, and reduced quality of life. Integrated multimodal pain management across the entire burn care continuum remains insufficiently studied. The purpose was to evaluate the effectiveness of a multimodal pain management strategy for both acute and chronic burn pain, focusing on pain intensity, functional recovery, and patient-centered outcomes from the acute phase through long-term recovery. Materials and methods. This prospective clinical study included 112 adult burn patients, comprising individuals with acute burn injury and chronic post-burn pain. A standardized multimodal pain management protocol was implemented, incorporating pharmacological analgesia, regional and interventional techniques, non-pharmacological interventions, and rehabilitation-oriented strategies. Pain management was individualized according to pain phenotype and stage of recovery. The primary outcome was pain intensity measured using a 0–10 Numeric Rating Scale. Secondary outcomes included procedural pain control, sleep quality, functional mobility, analgesic (including opioid) consumption, and quality-of-life indicators. Outcomes were assessed longitudinally during acute care and follow-up. Results. Multimodal pain management was associated with a significant reduction in pain intensity in both acute and chronic burn pain cohorts. Clinically meaningful pain reduction was achieved in a substantial proportion of patients across stages of care. Improved procedural pain tolerance, enhanced participation in rehabilitation, better sleep quality, and a reduction in opioid requirements were observed over time. No increase in serious adverse events related to pain management strategies was identified. Conclusions. In a cohort of 112 burn patients, implementation of a structured multimodal pain management approach addressing both acute and chronic pain was associated with improved pain control, functional recovery, and patient-centered outcomes from acute injury to long-term recovery. These findings support the integration of stage-specific, multimodal pain strategies into standard burn care and warrant further controlled studies to refine and validate optimal protocols.