Elsevier

Burns

Volume 44, Issue 4, June 2018, Pages 1005-1010
Burns

Effect of cold pack therapy for management of burn scar pruritus: A pilot study

https://doi.org/10.1016/j.burns.2018.01.011Get rights and content

Highlights

  • We investigated the effects of cold pack therapy on burn scar pruritus.

  • The numerical rating scale, 5-D Itch Scale, and Leuven Itch Scale were evaluated.

  • 20 °C cold pack therapy is a non-invasive modality that significantly reduced burn pruritus.

Abstract

Purpose

Pruritus, a common, chronically disabling condition is often refractory to treatment. The pruritus sensation is mediated in the spinal cord and post-burn pruritus is considered a form of neuropathic pain. We investigated cold pack therapy as a treatment modality for post-burn pruritus.

Methods

We studied 23 patients with severe pruritus scoring at least 5 on the visual analogue scale (VAS) and refractory to antihistamine and gabapentin administration. Each cold pack therapy lasted more than 20 min. Patients participated in more than three sessions daily for 4 consecutive weeks. The numerical rating scale (NRS), 5-D Itch Scale, Leuven Itch Scale, and perfusion units were evaluated before, within 30 min after, 2, and 4 weeks cold pack therapy.

Results

In all patients, the NRS was 9.37 ± 1.47 pre-therapy, 3.48 ± 2.19 at 2 weeks, and 2.78 ± 2.13 at 4 weeks following therapy, the pre-scores being significantly different (p < 0.001). Pruritus severity and consequences scores (Leuven Itch Scale) were improved after therapy compared to pre-therapy. Perfusion unit (PU) scores were statistically insignificant compared to PU scores measured before the application of cold pack therapy. Degree, direction, and disability scores (5-D Itch scale) significantly differed (p < .05).

Conclusion

Cold pack therapy, a non-invasive, non-pharmacological treatment modality significantly reduces post-burn pruritus and could be useful in burn patients.

Introduction

Post-burn pruritus is common problem associated with burns. Approximately 87% of patients discharged after treatment for burns are known to present with pruritus [1]. Empirical antipruritic treatment is usually ineffective because the pathophysiology of post-burn pruritus remains unclear. Some studies report refractory post-burn pruritus as a mechanism of, and pathophysiology similarities of neuropathic pain [2].

Cold therapy is a useful non-pharmacological treatment option following injuries. The primary goal of cold therapy is removal of heat from the injured site, in addition to pain relief [3], [4], [5]. Cold therapy produces physiological effects including a reduction in blood flow, edema, hypoxia, cellular metabolic rate, enzymatic activity, and tissue damage. It is also known to increase the pain threshold by decreasing nerve conduction velocity and muscle spasm [6], [7], [8]. Cold therapy has shown proven benefit in management of burn wounds primarily through pain reduction and preventing damage to the burned area during the acute phase [9]. Davies et al. have demonstrated a correlation between cold therapy and histamine release, indicating that the heat-induced immediate increase in capillary permeability is attributable to histamine release and that cold application of peritoneal mast cells in a rat model shows reversible inhibition of histamine release [10], [11]. This physiological effect induced by cold therapy has found clinical applicability to manage pruritus occurring in several diseases. Several clinical reports have compared the efficacy of a single application of cold therapy to an injured site with repeated application and noted that the latter produces a greater therapeutic effect [12].

However, to date, standard treatment protocols for post-burn pruritus have not been established at most clinical centers, and use of novel treatment protocols is being attempted. To our knowledge, no study has assessed the therapeutic benefit of repeated cold pack therapy to manage pruritus following the acute inflammatory phase in patients with burn injury. We aimed to evaluate the effect of cold pack therapy for the treatment of refractory post-burn pruritus and to understand the mechanisms of action associated with the use of cold pack therapy in post-burn pruritus using laser Doppler blood perfusion imaging.

Section snippets

Subjects and methods

We enrolled 23 adults who had presented with partial-to-full-thickness burns that had spontaneously healed or required skin grafting at the Department of Rehabilitation Medicine at Hangang Sacred Heart Hospital in Korea between June 2016 and July 2017. Our study was approved by the Ethics Committee of the Hangang Sacred Heart Hospital, and all patients provided written informed consent. Patients complained of severe pruritus rated at least 5 on the 10-point numerical rating scale (NRS), despite

Results

All 23 patients successfully completed the study in accordance with the study protocol. No complications or issues associated with the use of cold pack were noted in any patient. Values were presented as mean ± standard deviation. The measured NRS scores decreased significantly from 9.37 ± 1.47 points before cold therapy to 3.48 ± 2.19 points after 2 weeks of therapy (p < 0.001) and to 2.78 ± 2.13 points after 4 weeks of therapy (p < 0.001). The difference between the score after 2 weeks and the score

Discussion

Our study investigated the effect of cold pack therapy for the management of burn-associated pruritus in adults presenting with partial-to-full-thickness burns that had spontaneously healed or required skin grafting. Results indicate that cold pack therapy significantly reduced severity of post-burn pruritus and interference with activities of daily living in the experimental group. We objectively assessed perfusion levels in the burn areas after application of cold pack therapy and noted a

Conclusion

To our knowledge, this is the first report describing the use of cold pack therapy at 20 °C in patients with burns to treat post-burn pruritus. We found that is a clinically useful non-invasive treatment option to manage pruritus and should be considered an effective alternative modality for the treatment of burn-scar pruritus. However, we propose that future studies comprising a greater number of patients are warranted to determine the optimal treatment temperature and duration of cold therapy

Conflicts of interest

There are no conflicts of interest to declare.

Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education (2017R1D1A1A02018478, 2017R1D1A1B03029731), and the Korea Health Technology R&D Project, through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C1486).

References (32)

  • E. Brenaut et al.

    Pruritus: an underrecognized symptom of small-fiber neuropathies

    J Am Acad Dermatol

    (2015)
  • M. Vitale et al.

    Severe itching in the patient with burns

    J Burn Care Rehabil

    (1991)
  • I. Goutos

    Neuropathic mechanisms in the pathophysiology of burns pruritus: redefining directions for therapy and research

    J Burn Care Res

    (2013)
  • A.A. Algafly et al.

    The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance

    Br J Sports Med

    (2007)
  • O.J. Ofeigsson

    Water cooling: first-aid treatment for scalds and burns

    Surgery

    (1965)
  • D. Amtmann et al.

    Psychometric properties of the modified 5-D itch scale in a burn model system sample of people with burn injury

    J Burn Care Res

    (2017)
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    SYJ and JK contributed equally as first authors of this work.

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