Traditionally, full thickness burns have been thought to be painless due to destruction of underlying nerves. We explored the association between patient and burn characteristics and pain severity in burn patients and determined whether full thickness burns were less likely to be painful than more superficial burns.

We performed a structured review of medical records of patients presenting to a burn center between 2010 and 2013. Data abstracted included baseline patient and burn characteristics. The primary end point was pain severity on patient arrival to the emergency department using a verbal numeric score of 0 to 10. Univariate and multivariate analyses were used to explore the association between patient and burn characteristics and pain severity.

There were 507 patients. Mean (SD) age was 29.9 (23.6); 38% were ages younger than 18, and 68% were males. The median (interquartile ranges) pain score was 5 (2-8). Of all patients, 7% had isolated full thickness burns. Median (interquartile ranges) pain scores in isolated full thickness burns were slightly lower than in more superficial burns: 4 (1-8) vs 6 (2-8), respectively, P = .09. Twenty-five percent of patients with isolated full thickness burns had pain scores of 0 compared with 18% of all others (P = .28). There was no correlation between total body surface area and pain severity, however, pain scores increased with the number of burns (P = .007).

Pain severity is slightly less with full thickness burns; however, most patients have pain. The presence of pain should not be used to exclude full thickness burns.