Pain trajectories during acute hospitalization after burn injuries.

Abstract

Burn pain is complex and challenging to manage. Identifying patterns of pain progression during acute hospitalization may improve pain management strategies and outcomes. This study examined pain trajectory patterns and associated factors among burn patients during inpatient admission. A retrospective chart review was conducted for 442 patients admitted to a regional burn center. Daily pain scores were extracted from electronic medical records, and longitudinal k-means clustering was used to identify distinct pain trajectories and their associations with patient characteristics. Data from 417 patients (43,737 pain scores) were analyzed. Patients were mostly male (67%) and White (57%), with a median age of 52 years, a total body surface area burned (TBSA) of 6%, a length of stay (LOS) of 11 days, and a median pain score of 7. Two distinct pain trajectories emerged: High Pain (n = 249, 59.7%) and Low Pain (n = 168, 40.3%). Compared to the Low Pain group, the High Pain group had younger age (46 vs 59), and higher morphine milligram equivalents (24 vs 20). After adjusting for covariates, pain trajectory group membership was not significantly associated with LOS, while TBSA, age, and burn depth were strong predictors of LOS. Two distinct pain trajectories were identified, suggesting early identification of high-pain patients can assist with targeted interventions to support recovery and mitigate persistent pain.