title: Progress of clinical practice on the management of burn-associated pain: Lessons from animal models.
abstract: Opioid-based analgesics provide the mainstay for attenuating burn pain, but they have a myriad of side effects including respiratory depression, nausea, impaired gastrointestinal motility, sedation, dependence, physiologic tolerance, and opioid-induced hyperalgesia. To test and develop novel analgesics, validated burn-relevant animal models of pain are indispensable. Herein we review such animal models, which are mostly limited to rodent models of burn-induced, inflammatory, and neuropathic pain. The latter two are pain syndromes that provide insight into the pain caused by systemic pro-inflammatory cytokines and direct injury to nerves (e.g., after severe burn), respectively. To date, no single animal model optimally mimics the complex pathophysiology and pain that a human burn patient experiences. No currently available burn-pain model examines effects of pharmacological intervention on wound healing. As cornerstones of pain and wound healing, pro-inflammatory mediators may be utilized for insight into both processes. Moreover, common clinical concerns such as systemic inflammatory response syndrome and multiple organ dysfunction remain unaddressed. For development of analgesics, these aberrations can significantly alter the potential efficacy and/or adverse effects of a prescribed analgesic following burn trauma. We therefore suggest that a multi-model strategy would be the most clinically relevant when evaluating novel analgesics for use in burn patients.
authors.affiliation: United States Army Institute of Surgical Research, 3650 Chambers Pass, BHT1:Bldg 3610, JBSA Fort Sam Houston, TX 78234-6315, United States. Electronic address: Matthew.k.mcintyre3.vol@mail.mil.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: McIntyre
authors.affiliation: United States Army Institute of Surgical Research, 3650 Chambers Pass, BHT1:Bldg 3610, JBSA Fort Sam Houston, TX 78234-6315, United States. Electronic address: John.l.clifford11.civ@mail.mil.
authors.forename: John L
authors.initials: JL
authors.lastname: Clifford
authors.affiliation: Brooke Army Medical Center, Department of Anesthesia and Operative Services, San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Anesthesia Residency Program, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6315, United States. Electronic address: Christopher.v.maani.civ@mail.mil.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Maani
authors.affiliation: United States Army Institute of Surgical Research, 3650 Chambers Pass, BHT1:Bldg 3610, JBSA Fort Sam Houston, TX 78234-6315, United States. Electronic address: David.m.burmeister3.civ@mail.mil.
authors.forename: David M
authors.initials: DM
authors.lastname: Burmeister
mesh_terms: D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000818:Animals; D002056:Burns / Q000150:complications / Q000628:therapy*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D004195:Disease Models, Animal; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy* / Q000209:etiology; D007249:Inflammation; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D059226:Nociceptive Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: Allodynia; Analgesia; Animal models; Burn pain; Hyperalgesia