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University of Washington/Harborview Medical Center, Department of Rehabilitation Medicine, 325 Ninth Avenue, Box 359740, Seattle, WA 98104, USA. wiechman@u.washington.edu
Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. Practitioners in the field have been concerned about the suboptimal management of acute pain in this population. Recent studies have shown that greater levels of acute pain are associated with negative long-term psychologic effects such as depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. Research in other non-burn trauma populations has also pointed to the potential for unmanaged acute pain to delay wound healing and lead to other medical complications, such as infection and extended hospitalization period. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychologic and physiologic outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.
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