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This article was written by Bonnie Carney, PhD.
Our study, published in the Journal of Burn Care & Research, underscores the need to integrate mental health care and physical recovery for patients with burn injuries.
Burns are complex injuries, and recovery can be more than physical. Often, patients experience prolonged emotional recovery as well. They can face psychological injuries from traumatic experiences, the loss of loved ones, and the challenges of life after a severe burn.
Our retrospective study, published in the Journal of Burn Care & Research, examined the relationship between mental health and how patients experience pain and itching after fractional ablative CO2 laser scar revision (FLSR) treatment. It underscores the need for integrated mental health care to help patients recover from burn injuries.
Healing from a burn typically results in a scar, which can limit mobility and cause pain, itching, and other complications. As many as 90% of patients report itching after an injury, and more than 40% report that their itching continued for an average of seven years after the burn.
FLSR breaks down scar tissue, leading to the formation of more flexible skin. Yet some patients treated with FLSR continue to report disruptive levels of pain and itching that don’t respond well to medication.
We hear this feedback from our patients in The Burn Center at MedStar Washington Hospital Center. Their voices are at the center of this research, as we work to understand how to improve their recovery and their quality of life.
Studying the impact of mental health care.
To better understand the connection between pain, itching, and mental health, we designed a retrospective study that examined the anonymous records of 110 patients who received FLSR at MedStar Washington Hospital Center between 2018 and 2024.
We split these patients into two groups: those who had a diagnosed mental health condition and those who did not. We compared how these groups responded to treatment after three FLSR sessions in two main ways:
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Physical signs of scar healing (objective measures)
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Experience of pain and itching (subjective measures)
Both groups showed similar signs of physical healing. Yet our study found that despite being on similar medications for these symptoms, the group of patients with a mental health diagnosis reported a more significant reduction in pain and itching after FLSR than the group that did not have a mental health diagnosis.
This study suggests that cognitive behavioral therapy and other mental health treatments could improve how patients recover from burn injuries. Incorporating these services into therapy for all burn patients could help them experience less pain and itching during their recovery.
Related reading: Burn Rehabilitation: Helping Patients Recover Physically and Emotionally.
Breaking up problematic scars with FLSR.
Scars that form after a burn injury are made of skin that is tighter, denser, and stiffer than usual. They can make movement difficult because they’re inflexible, cause pain and be itchy.
FLSR treatment creates microscopic holes in the scar tissue, releasing tension and breaking it down. Over time, the body rebuilds more typical skin in its place. Same-day treatment sessions take 45 minutes or less.
On average, scars can reduce a patient’s range of motion to 70% of what they are accustomed to, limiting their ability to perform daily tasks. After one FLSR treatment, the range of motion can improve to 76%, and by the third treatment, patients can approach 90% of their former ability.
This change could mean returning to work and social outings for some patients whose scars had restricted them. The Burn Center has performed hundreds of these treatments each year since introducing FLSR in 2016.
Related reading: Research Examines Benefits of Oral Fluids in Burn Injury Care.
Integrated mental health services can help.
Daniel Schneider, PsyD, is the Burn Center’s dedicated psychologist. This unique position enables Dr. Schneider to focus on helping patients emotionally recover from a burn injury.
Working with patients, families, and providers, Dr. Schneider and his team have built an effective program to help patients in the hospital get treatment for the mental and emotional impacts of a burn injury. This includes techniques to help people facing medical trauma manage grief and stress, build mindfulness, and engage with cognitive behavioral therapy.
Our research indicates that there is an opportunity to provide similar services in an outpatient setting, allowing patients who return to the clinic for FLSR treatments to receive the benefits of mental health care as they recover.
Related reading: New Research Aims to Help Restore Skin Pigment in Burn Scars.
Collaborating to improve burn care.
At The Burn Center, we’re dedicated to improving care for patients. One way we do this is by creating an environment that trains the next generation of burn care providers and researchers. For instance, the authors of this study include medical and undergraduate students, surgeons, psychologists, researchers, and others collaborating to advance clinical care for our patients.
We work closely with our patients and their families each day to help them heal physically and emotionally after a burn injury. This is often a long and challenging process, as the body rebuilds lost skin and patients regain their confidence and heal from trauma.
This research is one example of how we’re learning more each day about how the body and mind heal after a burn. Further studies will help solidify this understanding, allowing us to bring more innovations to our patients.
