As in many other pain states, anxiety plays a significant role in the degree of pain felt by the patient (1). In burn patients, the difference is that the treatment for their underlying burn injury leads to significantly greater amounts of pain. Thus, the patient becomes scared and anxious about the actual therapy to improve their condition. This becomes even a greater problem when the therapeutic maneuvers are not adequately treated with pain medications. As a result, the patient becomes increasingly anxious about the upcoming therapies leading to increasing pain leading to increasing anxiety and so on. Many studies have described how the anticipation of the next dressing change or antibiotic application leads to fear that increases the pain perception. This cycle of anxiety and pain becomes very difficult to treat if not preempted by adequate analgesia during the earliest of therapies (2). The initial analgesia must be followed with adequate monitoring for changes in pain perception as the treatments are continued so that this cycle of anticipatory pain and anxiety is minimized or never started.

Because the nature of severe pain injuries involves a long, drawn-out therapeutic approach with continued or even worsening pain, many of these patients can become anxious, depressed, hostile, anhedonic, or regressed. All of these negative emotional states can increase the amount of pain felt by these patients. The longer the patients stay in the hospital, the more likely it is for the patient to experience one or more of these emotions in greater and greater amounts. These studies suggest that if we can control and decrease these emotions of depression and anxiety, their pain would be lessened and easier to control.