Hypnosis and pain control on an English burns unit.

Pain control, or the lack of it, is the most overwhelming and overriding concern of burns patients once the initial shock of the accident and admission to a burns unit are surmounted. It is perplexing to patients that they have to endure extraordinary amounts of pain when they are being cared for in modern intensive nursing units. The sources of pain are the damage caused to the skin and nerve endings. In the first hours of injury, partial thickness burns are painful because prostaglandins and histmaines released in the injured area stimulate peripheral pain receptors. Pain is accentuated if blisters break causing desiccation, which causes osmotic stimulation of nerve endings. Full thickness burns are initially painless as nerve endings are destroyed, but pain occurs later when nerves re-grow and are exposed. Over subsequent weeks, the wound is sensitive to atmospheric pressure producing arthritis like exacerbations of pain (Stein and Stein, 1983). There is also pain from nursing and medical procedures such as positioning, dressing changes and limb movements during physiotherapy. The author recently visited 16 burns units in the USA to study the problem of pain control. The impression was one of diverse practices adhered to dogmatically. This state of contradictory practices was confirmed by a survey of 151 North American burns units (Berry and