BACKGROUND: Non-pharmacological interventions are used alongside analgesia in burn care, but the evidence comes from clinically diverse interventions, populations, and settings.
METHODS: We searched nine databases from inception to July 1, 2026. Controlled studies of virtual reality, music, massage, hypnosis, relaxation, distraction, or structured psychological interventions in patients with burns were eligible. Continuous outcomes measuring the same construct were synthesized as Hedges'g standardized mean differences (SMDs) using random-effects models. Multi-arm trials contributed one independent study-level effect by combining eligible intervention arms sharing a common control. Risk of bias was assessed with RoB 2 or ROBINS-I, and certainty with GRADE.
RESULTS: Sixteen studies were included; 10 contributed to meta-analysis. Pain was lower with non-pharmacological interventions (4 studies, n=354; SMD=-0.78, 95% CI -1.27 to -0.29; I2=78.8%). A restricted pain analysis remained favorable (2 studies, n=206; SMD=-0.61, 95% CI -1.16 to -0.06). Randomized-trial analyses favored interventions for general anxiety (3 studies, n=261; SMD=-1.03, 95% CI -1.63 to -0.43) and depressive symptoms (2 studies, n=141; SMD=-1.31, 95% CI -1.91 to -0.72). Pain-related anxiety was lower in 2 studies (n=360; SMD=-0.83, 95% CI -1.28 to -0.38; I2=70.3%). Certainty was low for pain and pain-related anxiety and very low for general anxiety and depressive symptoms.
CONCLUSION: Selected interventions were associated with lower procedural pain, pain-related anxiety, and some short-term psychological symptoms. Substantial clinical and methodological heterogeneity limits the certainty and generalizability of the pooled estimates. These interventions should be considered adjuncts to, not replacements for, pharmacological analgesia and appropriate psychological care.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Physician rater
This analysis creates awareness of limitations in adjuvant non-pharmacological interventions in pain management in burn patients. We already know that pain perception continues for up to decades; however, the short period of effects of pain control other than pharmacological are confirmed from this study.
Rehab Clinician (OT/PT) rater
The authors conclude, "Substantial clinical and methodological heterogeneity limits the certainty and generalizability of the pooled estimates. These interventions should be considered adjuncts to, not replacements for, pharmacological analgesia and appropriate psychological care." The American Burn Association’s Committee on the Organization and Delivery of Burn Care revised adult pain guidelines in 2020: "The conclusion was that insufficient data existed to fully support high-level evidence-based standards of care." The absence of definitive and informed EBP does not appear to have changed in a compelling manner.
, McMaster University