Effect of cold pack therapy for management of burn scar pruritus: A pilot study
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).
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SYJ and JK contributed equally as first authors of this work.