Evidence-based pain management?

[Michael]

At much lower levels of pain, I've found the opposite of what he says to be true, because quick and dirty shortens the anticipation of pain, which in itself can be at least as painful as the sensation. How about you?

[Mateo_1387]

What the man in the video is saying makes sense. I would think that slowly removing bandages of the burn victim would be better, because those procedures are usually augmented with pain management. Low levels of pain, treated with pain medication, makes sense, to me. Even with pain management, intense bandage ripping probably intensifies the pain past the level treated by the medication. But, this is just me rambling about how it may be, truth is I am not really sure.

The anxiety before knowing something painful is about to be done is killer !

[VentMedic]

My questions to him would include at what point in time did he start noticing the way they were removing his bandage? Did either the meds or his injury skew his judgement of time? What meds were the using for pain management? Since he was not on a ventilator, his meds were probably not as heavy. Although, had he stayed on a ventilator, VAP would always have been an issue. Where was this and what was the temperature of the room the dressing changes were being done? Were the nurses thinking of heat loss if dressing changes took too long? Did the nurses vary their technique with other patients?

The guy looked much younger in the photos and burn management has progressed greatly over the past 20 years. Doctors and Critical Care medicine have also greatly changed their perception of pain over the past 20 years.

Very few of the severely burned patient I have spoken with once they are out of BICU remember the early weeks.

I would say our nurses remove the bandages at a moderate to slightly slower pace to protect the grafts. That also keeps fluids and skin from being flung everywhere. The environment also is very controlled for temperature. It can take up to 2 hours or more, depending on their cleansing method, to unbandage and rebandage a patient that severe. Of course, a lot depends on the degree of the burns.

Fascinating area of research. The Burn journal has lots of information and opinions on this.

http://www.ameriburn.org/

http://www.worldburn.org/documents/painmanage.pdf

[firedoc5]

What the man in the video is saying makes sense. I would think that slowly removing bandages of the burn victim would be better, because those procedures are usually augmented with pain management. Low levels of pain, treated with pain medication, makes sense, to me. Even with pain management, intense bandage ripping probably intensifies the pain past the level treated by the medication. But, this is just me rambling about how it may be, truth is I am not really sure.

The anxiety before knowing something painful is about to be done is killer !

I must agree with your last statement, Matt. People knowing that it's going to hurt is going to be more apprehensible. Hence, almost hightening the pain sensation.

I've worked with too many burn patients and I've seen it done slowly and I've seen it done fast. In my observation it was inconclusive which worked better. I think it depends on the person themselves. Some are very fearful to feel pain, some are like, "Bring it on! I can handle it."