ABSTRACT
The distinction of the acute pain state from the chronic pain state is one which is discussed in other chapters in this book. Chronic pain may be considered a disease, with its own natural history and presentation and its own treatments and techniques, whereas acute pain is a simpler model and is more easily understood by a person with a conventional biomedical training. There are, however, a few areas in clinical practice where the biology and the psychology of both acute and chronic pain states must be considered simultaneously and burn injury is one such area. Observation of the way in which casualties of the Anzio invasion force of 1944 viewed their serious wounds influenced the development of the model for pain pathways that we call the ‘gate control’ model. On a battlefield the prospect of a safe transfer, with honour, from a place of danger to a place of safety has been said to contribute to a sense of wellbeing, even analgesia. By contrast, in civilian practice, burn casualties might be considered the most extreme example of the way in which the circumstances contribute to adverse psychological outcomes, as the gate control mechanism may not work. Burn injuries are not only physically very painful, they are associated with devastating endocrine and metabolic changes, physical changes are often permanent, and psychological consequences of, for example, facial disfigurement, or the circumstances of the incident have to be considered from the very early stages.
