Local cooling does not prevent hyperalgesia following burn injury in humans.
One of the oldest methods of pain relief following a burn injury is local application of ice or cold water. Experimental data indicate that cooling may also reduce the severity of tissue injury and promote wound healing, but there are no controlled studies in humans evaluating the anti-inflammatory or anti-hyperalgesic potential of early cooling after thermal injury. Twenty-four healthy volunteers participated in this randomized, single-blinded study. Following baseline measurements, which included inflammatory variables (skin temperature, erythema index) and sensory variables (thermal and mechanical detection thresholds, thermal and mechanical pain responses, area of secondary hyperalgesia), first degree burn injuries were induced on both calves by contact thermodes (12.5 cm(2), 47 degrees C for 7 min). Eight minutes after the burn injury, contact thermodes (12.5 cm(2)) were again applied on the burns. One of the thermodes cooled the burn (8 degrees C for 30 min) whereas the other thermode was a non-active dummy on the control burn. Inflammatory and sensory variables were followed for 160 min after end of the cooling procedure. The burn injury induced significant increases in skin temperature (P<0.0005), erythema index (P<0.0001), thermal pain responses (P<0.0005), mechanical pain responses (P<0.005) and secondary hyperalgesia, and significant decreases in heat pain threshold (P<0.0005) and mechanical pain threshold (P<0.0005). There were no post-cooling effects on skin temperature (P>0.5), erythema (P>0.9), heat pain threshold (P>0.5), thermal or mechanical pain responses (P>0.5) or the development of secondary hyperalgesia (P>0.4) compared with the control burn. However, a significant, albeit transient, increase in cold detection threshold was observed on the cooled burn side (P<0.0001). In conclusion, cooling with 8 degrees C for 30 min following a first degree burn injury in humans does not attenuate inflammatory or hyperalgesic responses compared with a placebo-treated control burn.
Acute Pain Service, Department of Anesthesiology, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark Department of Pediatrics, Hvidovre University Hospital, Copenhagen, Denmark Department of Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark.
Mads U
MU
Werner
Birgit
B
Lassen
Juri L
JL
Pedersen
Henrik
H
Kehlet
D000704:Analysis of Variance; D019540:Area Under Curve; D002056:Burns / Q000150:complications / Q000628:therapy*; D003080:Cold Temperature; D004890:Erythema / Q000209:etiology; D006801:Humans; D006930:Hyperalgesia / Q000517:prevention & control*; D007249:Inflammation / Q000517:prevention & control; D008297:Male; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D016037:Single-Blind Method; D012881:Skin Temperature / Q000502:physiology; D018709:Statistics, Nonparametric