1
|
Coletta F, Pirolli R, Annunziata R, Nugnes M, Tommasello A, Villani R, Giaccari LG, Passavanti MB, Pace MC, Sansone P. Efficacy and Adverse Effects of IV Morphine for Burn Pain Management in the Emergency Department: An Observational Study. Pain Ther 2024; 13:857-864. [PMID: 38795311 PMCID: PMC11254875 DOI: 10.1007/s40122-024-00595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/18/2024] [Indexed: 05/27/2024] Open
Abstract
INTRODUCTION The management of pain following a burn is extremely complex because of the multifactorial nature of burn pain (nociceptive and neuropathic). In the pre-hospital setting and emergency department (ED), the main goal of acute pain management is to reduce the patient's pain, allowing them to maintain function and to prevent the chronification of pain. Opioids are used as first-line treatment in management of burn pain. The aim of our study was to evaluate the efficacy and adverse effects of intravenous (IV) morphine for burn pain management in the ED and to evaluate pain management in the pre-hospital setting. METHODS In this single-center observational study, patients presenting with second- and third-degree burns were enrolled in our ED. Numerical Rating Scale (NRS) and Burn Specific Pain Anxiety Scale (BSPAS) were performed at ED admission and after 1 h. Pain medications administered before arrival in the ED were reported by the rescue team. All patients received IV acetaminophen every 8 h and IV morphine according NRS. RESULTS Thirty patients were included in this study. At the time of arrival to the ED, > 90% of the patients reported severe pain; 95.8% of them received IV morphine to achieve pain relief. After 1 h, > 65% of patients had NRS < 3. The total amount of IV morphine was 18.12 ± 4.26 mg in the first hour. No adverse events were recorded. The BSPAS on admission to the ED was 34.8 ± 5.6, indicating severe anxiety. After 1 h, BSPAS was 12.8 ± 4.8, indicating mild anxiety. CONCLUSION IV morphine used for burn pain management in the emergency setting significantly improves patient outcomes in terms of pain. IV morphine also reduced anxiety scores at 1 h.
Collapse
Affiliation(s)
- Francesco Coletta
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Rossella Pirolli
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Raffaele Annunziata
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Manuela Nugnes
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Antonio Tommasello
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Romolo Villani
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Luca Gregorio Giaccari
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy.
| | - Maria Beatrice Passavanti
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
| | - Pasquale Sansone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
| |
Collapse
|
2
|
Kowalski G, Domagalska M, Słowiński K, Grochowicka M, Zawadzki M, Kropińska S, Leppert W, Wieczorowska-Tobis K. Morphine (10, 20 mg) in a Postoperative Dressing Used with Patients After Surgical Debridement of Burn Wounds: A Prospective, Double-Blinded, Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2024; 13:115-122. [PMID: 37742106 DOI: 10.1089/wound.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
Objective: This is the first clinical trial to evaluate the analgesic effect of 10 and 20 mg of morphine used in a postoperative dressing with patients after surgical debridement of burn wounds. Approach: In this randomized controlled trial, 20 adult patients with third-degree flame burns, who had undergone surgical debridement under general anesthesia, were randomly assigned to either group A, whose members were treated with a burn dressing that contained 10 mg of morphine, or group B, whose members were treated with a burn dressing that contained 20 mg of morphine; the dressing was also soaked with octenidine and phenoxyethanol in the case of both groups. The plasma morphine concentrations were measured 1, 2, 3, and 6 h after surgery, while the level of pain intensity was determined on the Numeric Pain Rating Scale (NRS), and the occurrence of side effects was observed. Results: The serum morphine concentration levels were very low, but statistically different between the two groups at all time points. The NRS value was similar in both groups at all time points (p > 0.05). Despite this, in group B, the NRS value was 0 in all patients in postoperative hours 1, 2, and 3. No adverse effect of morphine sulfate was observed in any patient. Innovation: This project is the first clinical study to have demonstrated that morphine administered in dressings in concentrations of 0.02-0.08 mg/mL significantly reduces the occurrence of pain. Conclusion: The use of morphine in dressings after surgical treatment of burn wounds is very effective when it comes to pain management and is safe for the patient.
Collapse
Affiliation(s)
- Grzegorz Kowalski
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Małgorzata Domagalska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Krzysztof Słowiński
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Grochowicka
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Marcin Zawadzki
- Wroclaw Medical University Department of Forensic Medicine, Wroclaw, Poland
| | - Sylwia Kropińska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Wojciech Leppert
- Chair of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
- University Hospital of Heliodor Święcicki, Partner of Poznań University of Medical Sciences, Poznań, Poland
| | | |
Collapse
|
3
|
Kowalski G, Leppert W, Domagalska M, Grochowicka M, Teżyk A, Słowiński K, Bienert A, Szkutnik-Fiedler D, Wieczorowska-Tobis K. Analgesic Efficacy of Oxycodone in Postoperative Dressings after Surgical Treatment of Burn Wounds: A Randomised Controlled Trial. J Clin Med 2024; 13:784. [PMID: 38337478 PMCID: PMC10856020 DOI: 10.3390/jcm13030784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. MATERIAL AND METHODS Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia were included. Burn wounds were treated with dressings, to which oxycodone was added at 20 mg in Group 1 and 10 mg in Group 2. After the surgery, plasma oxycodone and noroxycodone concentrations were assayed, and pain intensity was assessed with Numerical Rating Scale (NRS). RESULTS In Group 1, no patient reported pain; in Group 2, four patients reported pain. The pain intensity, according to NRS, was 1-8. Plasma concentration of oxycodone in the blood serum was in the range of 1.24-3.15 ng/mL and 1.09-1.28 ng/mL in Group 1 and Group 2, respectively. Noroxycodone was not detected in the plasma. Adverse effects were not observed in any of the treated patients. CONCLUSIONS Oxycodone in dressings provides patients with adequate and safe analgesia.
Collapse
Affiliation(s)
- Grzegorz Kowalski
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
- Department of Anesthesiology, Józef Struś Multiprofile Municipal Hospital, 61-701 Poznań, Poland
| | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Małgorzata Domagalska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Monika Grochowicka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Artur Teżyk
- Department of Forensic Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Krzysztof Słowiński
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Agnieszka Bienert
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Danuta Szkutnik-Fiedler
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| |
Collapse
|
4
|
Jeffs DA, Spray BJ, Baxley L, Braden E, Files A, Marrero E, Teague T, Teo E, Yelvington M. Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial. J SPEC PEDIATR NURS 2024; 29:e12419. [PMID: 38095116 DOI: 10.1111/jspn.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE This study compared the effectiveness of age-appropriate, high technology, interactive virtual reality (VR) distraction with standard care (SC) provided by the nurse on adolescents' acute procedural pain intensity perception during burn wound care treatment in the ambulatory clinic setting. DESIGN This randomized controlled trial included 43 adolescents ages 10-21 from the ambulatory burn clinic of a large children's hospital. METHODS Blinded study participants were randomly assigned to either VR or SC (non-significantly different, current mean burn surface area, 1.3 and 1.7, respectively) during the first burn wound care procedure in the burn clinic. Blinded research staff collected pre-procedure data including Spielberger's State-Trait Anxiety Inventory and postprocedure wound care pain intensity using the Adolescent Pediatric Pain Tool. A total of 41 participants completed all study procedures. RESULTS No statistically significant difference in burn wound care procedural pain was noted between the VR and SC groups after adjusting for several factors. Pre-procedure state and trait anxiety correlated with reported pre-procedure pain. Wound care pain was found to be significantly associated with pre-wound care pain score, time from original burn to clinic burn care treatment, and length of wound care treatment. These factors accounted for approximately 45% of the variation in pain scores during wound care treatment. PRACTICE IMPLICATIONS VR distraction can be a useful pain management strategy but may not take the place of the unique nurse-patient relationship that occurs during clinical encounters. Tailoring pain management during burn wound care requires consideration of anxiety, time from the burn injury to the wound care procedure, length of time of the wound care procedure, and pretreatment pain level. Knowing patients' needs, desires, and temperaments along with the specifics about the healthcare procedures are critical to formulating individualized care plans that may or may not include VR. Newer technology, such as easier-to-use, less expensive VR, may assist with translation into practice making its clinical use more routine.
Collapse
Affiliation(s)
| | - Beverly J Spray
- Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Lauren Baxley
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Eric Braden
- Arkansas Children's, Little Rock, Arkansas, USA
| | - Amber Files
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | - Tiffany Teague
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Esther Teo
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Burn Surgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Miranda Yelvington
- Rehabilitation Services, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| |
Collapse
|
5
|
Villarreal E, Wolf SE, Golovko G, Bagby S, Wermine K, Gotewal S, Obi A, Corona K, Huang L, Keys P, Song J, El Ayadi A. Opioid prescription and opioid disorders in burns: A large database analysis from 1990 to 2019. Burns 2023; 49:1845-1853. [PMID: 37872016 DOI: 10.1016/j.burns.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/28/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Opioids remain crucial in the management of burn pain. A comprehensive analysis of opioid use in burns and their complications has not been investigated. METHODS Data were collected from TriNetX, a large multicenter database with de-identified patient information. The population included patients prescribed opioids on or following burn injury from January 1st, 1990, to December 31st, 2019. Opioid prescription use was analyzed after cohort stratification by decades: 1990-1999, 2000-2009, and 2010-2019. Outcomes for opioid-related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders from psychoactive substance use were investigated. RESULTS Hydrocodone was the most frequently prescribed opioid in 1990-1999 and 2000-2009, with oxycodone taking the lead in 2010-2019 (p < 0.0001). During 1990-1999, patients had a decreased risk of recorded opioid-related disorders (RR=0.52), opioid dependence (RR=0.46), opioid abuse (RR=0.55), mental and behavioral disorders (RR=0.88), and intentional self-harm (RR=0.37) when compared to 2000-2009. A comparison of the 2000-2009-2010-2019 cohorts showed an increased risk of recorded opioid-related disorders (RR= 1.91), opioid dependence (RR=1.56), opioid abuse (RR=1.67), mental and behavioral disorders (RR =1.73), and intentional self-harm (RR=2.02). CONCLUSIONS The risk of opioid-related disorders has nearly doubled since the year 2000 warranting precautions when prescribing pain medications to burn patients.
Collapse
Affiliation(s)
- Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - George Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, TX, USA
| | - Shelby Bagby
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ann Obi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
6
|
Liechty KL, Shields K, Ogden E, Eshraghi N, Dedeo M, Bishop P. A Multimodal Pain Management Strategy for Burn Patients. Pain Manag Nurs 2023; 24:44-51. [PMID: 36319550 DOI: 10.1016/j.pmn.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/02/2022] [Accepted: 09/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute burn pain is difficult to manage, and poorly managed pain can lead to deleterious consequences such as post-traumatic stress disorder, prolonged recovery, chronic pain and long-term dependence on opioids. Understanding the role of nursing in promoting self-efficacy and minimizing opioid use is valuable. It is unknown whether strategic efforts aimed at enhancing patient self-efficacy will improve pain managment and lessen opioid requirements in the adult burn population. AIM The aim of this study was to examine the effect of a multi-modal, interdisciplinary pain management strategy on coping self-efficacy, pain scores, and opioid use in adult burn patients in the acute care setting. METHOD A quasi-experimental pre-test/post-test design was employed in an American Burn Association (ABA) verified burn center in the Pacific Northwestern United States. Data were collected prospectively for a 6-month period on 44 burn patients. The comparison group received usual care (n = 28), and the intervention received a pain management protocol (n = 16). Coping self-efficacy was measured on admission and at discharge in both groups using the Coping Self-Efficacy Scale. Numeric pain scores and opioid use in morphine milligram equivalents were averaged for each participant. Burn nurse perceptions were gathered via an anonymous electronic survey post data collection in February 2021. RESULTS There were no significant differences in measured coping self-efficacy, pain scores, or opioid use between the intervention and comparison groups. A significant positive correlation was found between length of stay, size of burn, and coping self-efficacy and problem focused self-efficacy. Burn nurses reported increased use of nonpharmacologic adjuncts since protocol implementation. CONCLUSION Nonpharmacologic adjuncts are more likely to be used consistently when protocolized. There is also evidence to support that certain aspects of self-efficacy may be enhanced during acute phase of burn care.
Collapse
Affiliation(s)
- Kara L Liechty
- Legacy Good Samaritan Pain Management Center, Portland, Oregon; Legacy Emanuel Oregon Burn Center, Portland, Oregon.
| | - Kelly Shields
- Legacy Health, Portland, Oregon; Legacy Emanuel Oregon Burn Center, Portland, Oregon
| | - Emily Ogden
- Legacy Emanuel Oregon Burn Center, Portland, Oregon
| | - Niknam Eshraghi
- Legacy Emanuel Oregon Burn Center, Portland, Oregon; General Surgery & Burn Specialists, Portland, OR
| | - Michelle Dedeo
- Providence Swedish, Seattle, Washington; Old Dominion University, Virginia Beach, Virginia
| | | |
Collapse
|
7
|
Muacevic A, Adler JR, Papadopoulou S, Lavrentieva A. Sedation With Dexmedetomidine in Critically Ill Burn Patients Reduced Delirium During Weaning From Mechanical Ventilation. Cureus 2022; 14:e31813. [PMID: 36579227 PMCID: PMC9782418 DOI: 10.7759/cureus.31813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Weaning of mechanical ventilation while maintaining appropriate pain control and preventing delirium is one of the most challenging aspects of burn care. Dexmedetomidine, an α2-adrenergic receptor agonist used for sedation may improve intensive care unit (ICU) patients' arousal status and enhance patient comfort. OBJECTIVES To determine the efficacy of dexmedetomidine vs. standardized usual care (midazolam or propofol) in maintaining sedation and reducing delirium in burn patients while weaning off mechanical ventilation. MATERIAL AND METHODS A total of 56 mechanically ventilated patients who fulfilled the criteria for weaning were enrolled in the study. Group 1 (26 patients) received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.1 mcg/kg/h. Group 2 (30 patients) received usual sedation with midazolam 0.08 mg/kg/h or propofol 15- 30 mcg /kg/min). RESULTS Dexmedetomidine was not associated with a significantly shorter duration of mechanical ventilation (Mean {IQR}: 9.3 {4,12} versus 7.5 {4,10}, p=0.3). Patients who received dexmedetomidine had a lower delirium rate (38,4% on Day 1 to 7,7% on Day 5) in comparison with patients from the usual care group (53,3% on Day 1 to 20% on Day 5) during the five days after the onset of weaning process (p=0.02) and had less need for supplemental use of analgesia (23.1% versus 53.3%, p=0.045) and antipsychotic agents (15.4% versus 53.3%, p=0.01). The most notable adverse effect of dexmedetomidine was bradycardia. CONCLUSIONS Dexmedetomidine may provide effective light sedation and is associated with fewer sedation-related adverse effects in burn patients. Sedation with dexmedetomidine during the weaning process in adult burn patients was associated with lower delirium rates, a trend towards the earlier withdrawal of mechanical ventilation but did not seem to improve the total duration of mechanical ventilation.
Collapse
|
8
|
Alrimy T, Alhalabi W, Malibari AA, Alzahrani FS, Alrajhi S, Alhalabi M, Hoffman HG. Virtual Reality Animal Rescue World: Pediatric virtual reality analgesia during just noticeable pressure pain in children aged 2-10 years old (crossover design). Front Psychol 2022; 13:963765. [PMID: 36389517 PMCID: PMC9651058 DOI: 10.3389/fpsyg.2022.963765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/03/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND AIMS Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10. METHODS A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain). RESULTS A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t(39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t(39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10. CONCLUSION During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups.
Collapse
Affiliation(s)
- Taima Alrimy
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wadee Alhalabi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Computer Science, School of Engineering, Computing and Informatics, Dar Al-Hekma University, Jeddah, Saudi Arabia
| | - Areej A. Malibari
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Sharifah Alrajhi
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alhalabi
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hunter G. Hoffman
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| |
Collapse
|
9
|
Ding X, Cui H, Ma P, Chen X, Sun Y, Qu M, Yan Z. Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial. Front Pharmacol 2022; 13:965441. [PMID: 36160398 PMCID: PMC9490052 DOI: 10.3389/fphar.2022.965441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to compare dexmedetomidine-butorphanol (DB) and midazolam-butorphanol (MB) combinations for sedation, and analgesia in burn patients undergoing dressing changes.Methods: A total of 56 ASA I–II burn patients were included in this single-center randomized clinical trial. The ages of these patients were between 20 and 60 years. TBSA ranged from 10% to 50%. They were randomized to group DB and group MB during dressing change. In the DB group, each patient received a bolus dose of dexmedetomidine (0.5 μg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). In the MB group, each patient received a bolus dose of midazolam (0.05 mg kg−1) and intermittent boluses of butorphanol (20 μg kg−1). The primary outcomes were sedation scores and pain scores. The second outcomes were vital signs, side effects, and butorphanol consumption.Results: The sedation scores of these two groups did not differ significantly (p > 0.05), and the pain scores of these groups were not significantly different (p > 0.05). More patients had hypotension in the DB group than in the MB group (6 versus 0, p = 0.01), but the number of patients who had respiratory depression was higher in the MB group compared with the DB group (4 versus 0, p = 0.038). Butorphanol consumption in the MB group was higher than in the DB group (p = 0.025).Conclusion: Dexmedetomidine is comparable to midazolam when combined with butorphanol in burn patients during dressing change. Compared with midazolam, it has the advantage of opioid-sparing effect.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx&proj=130622], identifier [ChiCTR2100049325].
Collapse
Affiliation(s)
- Xianchao Ding
- Department of Burn and Plastic Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hengfeng Cui
- Department of General Surgery, Third People’s Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Peng Ma
- Department of Anesthesiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xi Chen
- Department of Surgery, The Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yan Sun
- Department of Nosocomial Infection Management, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Minye Qu
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Minye Qu, ; Zhixin Yan,
| | - Zhixin Yan
- Department of Burn and Plastic Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Minye Qu, ; Zhixin Yan,
| |
Collapse
|
10
|
Tuleubayev B, Ogay V, Anapiya B, Zhylkibayev A, Saginova D, Koshanova A, Kurmangaliyev YD, Tezekbayev K, Bikonurov N, Abugaliyev K. Therapeutic Treatment of 2A Grade Burns with Decellularized Bovine Peritoneum as a Xenograft: Multicenter Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060819. [PMID: 35744082 PMCID: PMC9230981 DOI: 10.3390/medicina58060819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Homogeneous and xenogenic bioengineering structures are actively used as wound coatings in treatment of burns and have already shown their effectiveness. Nevertheless, the disadvantage of such dressings is their high cost. This issue is particularly challenging for developing countries in which the incidence of burns is the highest one. With such needs taken into account, the research team developed and clinically tested a new wound coating based on decellularized bovine peritoneum (DBP). Materials and Methods: A multicenter randomized clinical trial was conducted to evaluate DBP. The following variables were considered in the research study: the number of inpatient days, the number of dressing changes, the level of pain experienced during dressing changes, and the condition of wounds at the time of the follow-up examination. Results: The research involved 68 participants. It was found that the patients who were treated with a DBP experienced less pain with less changes of dressings. However, the number of inpatient days and wound healing failed to demonstrate statistically significant difference compared to the control group. Conclusions: In the given research, DBP showed efficacy in improving patients' quality of life by reducing pain and the number of dressings' changes. However, when comparing this research study with the studies of other animal-derived wound coverings, there were a number of differences and limitations in the parameters. Thus, the results requires further study for a greater comparability of data. Given the above, we expect that DBP will become an inexpensive and effective treatment for burns in developing countries.
Collapse
Affiliation(s)
- Berik Tuleubayev
- Surgical Diseases Department, Karaganda Medical University, 40 Gogol str., Karaganda 100000, Kazakhstan; (B.T.); (A.K.)
| | - Vyacheslav Ogay
- Stem Cells Laboratory, National Center for Biotechnology, 13/5 Korgalzhyn Ave., Nur-Sultan 01000, Kazakhstan;
- “X-Matrix” LLP, 13/5 Korgalzhyn Ave., Nur-Sultan 01000, Kazakhstan;
| | - Baurzhan Anapiya
- Surgical Diseases Department, Karaganda Medical University, 40 Gogol str., Karaganda 100000, Kazakhstan; (B.T.); (A.K.)
- Department of Multidisciplinary Surgery, National Research Oncology Centre, 3 Kerei-Zhanibek Khandar str., Nur-Sultan 01000, Kazakhstan
- Correspondence: ; Tel.: +7-707-226-2728
| | - Assylbek Zhylkibayev
- Department of Optometry and Vision Science, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Laboratory of Applied Genetics, National Center for Biotechnology, Nur-Sultan 01000, Kazakhstan
| | - Dina Saginova
- National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, 15a Abylay khan Ave., Nur-Sultan 01000, Kazakhstan;
| | - Amina Koshanova
- Surgical Diseases Department, Karaganda Medical University, 40 Gogol str., Karaganda 100000, Kazakhstan; (B.T.); (A.K.)
| | - Yerkin-Dauir Kurmangaliyev
- Multidisciplinary Hospital named after Professor H.Zh. Makazhanov, 5/3 Mukanov str., Karaganda 100000, Kazakhstan;
| | - Kanat Tezekbayev
- Department of Traumatology and Orthopedics, Kazakh National Medical University, 220 Papanina str., Almaty 050000, Kazakhstan;
| | - Nurzhan Bikonurov
- Burn Department, Municipal Clinical Hospital №4, Almaty 050000, Kazakhstan;
| | - Kabylbek Abugaliyev
- “X-Matrix” LLP, 13/5 Korgalzhyn Ave., Nur-Sultan 01000, Kazakhstan;
- Department of Multidisciplinary Surgery, National Research Oncology Centre, 3 Kerei-Zhanibek Khandar str., Nur-Sultan 01000, Kazakhstan
| |
Collapse
|
11
|
Care of the Critically Injured Burn Patient. Ann Am Thorac Soc 2022; 19:880-889. [PMID: 35507538 DOI: 10.1513/annalsats.202110-1099cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Care of the critically injured burn patient presents unique challenges to the intensivist. Certified burn centers are rare and geographically sparse, necessitating that much of the initial management of patients with severe burn injuries must happen in the pre-burn center setting.1 Severe burn injuries often lead to a wide range of complications that extend beyond the loss of skin integrity and require specialized care. As such, medical intensivists are often called upon to stabilize these critically injured patients. This focused review outlines the clinical care of these medically complex patients, including airway management, post-burn complications, volume resuscitation, nutrition, and end-of-life care.
Collapse
|
12
|
Goder D, Eshkol-Yogev I, Matsliah L, Lemberger M, Harlev M, Furer A, Zilberman M, Egozi D. In vivo study of the efficacy of bupivacaine-eluting novel soy protein wound dressings in a rat burn model. Burns 2022; 48:623-632. [PMID: 34330581 DOI: 10.1016/j.burns.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Dealing with wound related pain is an integral part of treatment. Systemic administration of analgesic and anesthetic agents is a common solution for providing pain relief to patients but comes at a risk of severe side effects as well as addiction. To overcome these issues, research efforts were madeto provide a platform for local controlled release of pain killers. We have developed a bilayer soy protein-based wound dressing for the controlled local release of bupivacaine to the wound site. The combination of a dense and a porous layer provides a platform for cell growth and proliferation as well as physical protection to the wound site. The current study focuses on the in vitro bupivacaine release profile from the dressing and the corresponding in vivo results of pain levels in a second-degree burn model on rats. The Rat Grimace Scale method and the Von Frey filaments method were used to quantify both, spontaneous pain and mechanically induced pain. A high burst release of 61.8 ± 1.9% of the loaded drug was obtained during the initial hour, followed by a slower release rate during the following day. The animal trials show that the RGS scores of the bupivacaine-treated group were significantly lower than these of the untreated group, proving a decrease of 51-68% in pain levels during days 1-3 after burn. Hence, successful pain reduction of spontaneous pain as well as mechanically induced pain, for at least three days after burn was achieved. It is concluded that our novel bupivacaine eluting soy protein wound dressings are a promising new concept in the field of local controlled drug release for pain management.
Collapse
Affiliation(s)
- Daniella Goder
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Inbar Eshkol-Yogev
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Matsliah
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Moran Lemberger
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Mickey Harlev
- Veterinary Service Center, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Furer
- Medical Corps, Israel Defense Forces, Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Dana Egozi
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| |
Collapse
|
13
|
Polychronopoulou E, Kuo YF, Wilkes D, Raji MA. Prescribing of Gabapentinoids with or without opioids after burn injury in the US, 2012-2018. Burns 2022; 48:293-302. [PMID: 34991930 PMCID: PMC9007844 DOI: 10.1016/j.burns.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Burn injury pain manifests as a combination of inflammatory, nociceptive, and neuropathic features. While opioids are the mainstay of burn pain management, non-opioid medications, such as gabapentinoids, have also been considered as they target the central nervous system. Increased opioid adverse events and overdose deaths in the United States led to the 2014 and 2016 guidelines to reduce opioid prescribing and consider alternatives, such as gabapentinoids. In the context of burn, the rate of gabapentinoid prescribing at the national level is unknown and it is unclear whether any shift has occurred in prescribing practices over time. We conducted a population level cohort study of adult burn patients from 2012 to 2018 to evaluate the rates and determinants of gabapentinoid prescribing, with and without opioids. Of 98,001 patients with burn, 22,521 (22.98%) received opioids and/or gabapentinoids (GABA). GABA represented 2.4% of prescriptions in 2012, but increased to 7.2% by 2018, while GABA-opioid co-prescriptions increased from 2.3% to 5.1%. The rate of increase in GABA prescriptions was higher for those aged 50-65 years or residing in the South. After adjustment, GABA was 44% more likely to be prescribed in 2017 and 2018 compared to 2012 and 2013, opioids were 38% less likely, while co-prescribing did not show a statistically significant change. Our study showed a modest increase in gabapentinoids' outpatient prescribing for burn patients after the 2014 and 2016 guidelines, indicating more opportunities for prescribers to expand non-opioid pain management in this population.
Collapse
Affiliation(s)
- Efstathia Polychronopoulou
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Division of Rehabilitation Sciences, University of Texas Medical Branch
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch,Institute for Translational Sciences, University of Texas Medical Branch
| | - Denise Wilkes
- Department of Anesthesiology, The University of Texas Medical Branch
| | - Mukaila A. Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch
| |
Collapse
|
14
|
Goder D, Giladi S, Furer A, Zilberman M. Bupivacaine-eluting soy protein structures for controlled release and localized pain relief: An in vitro and in vivo study. J Biomed Mater Res A 2021; 109:1681-1692. [PMID: 33728803 DOI: 10.1002/jbm.a.37163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
Burn pain is known to be excruciating, and while burn care has greatly advanced, treatment for burn-related pain is lacking. Current pain relief methods include systemic administration of analgesics, which does not provide high drug concentration at the wound site. In the present study, soy protein was used as the base material for bupivacaine-loaded hybrid wound dressings. The effect of the formulation on the drug release profile was studied using high performance liquid chromatography, and the cytotoxicity was tested on human fibroblasts. A second-degree burn model in rats was used to quantify the efficacy of the wound dressings in vivo, using the Rat Grimace Scale. All tested films exhibited high biocompatibility, and the drug release profiles showed rapid release during the initial 5 hr and a continuous slower release for another 24 hr. Significant pain relief was achieved in the animal trials, proving a decrease of 51-68% in pain levels during days 1-3 post-burn. Hence, the results indicate a safe and controlled bupivacaine release for a period of more than 24 hr, effectively treating pain caused by second-degree burns. The understanding of the formulation-properties effects, together with our in vivo study, enables to advance this field toward tailorable systems with high therapeutic potential.
Collapse
Affiliation(s)
- Daniella Goder
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shir Giladi
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Furer
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University Hadassah School of Medicine, Jerusalem, Israel
| | - Meital Zilberman
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Chaghazardi S, Hedari M, Bazargan-Hejazi S, Mohammadi R, Ahmadi A. Comparing the Effect of Gabapentin, Ketamine, Dexmedetomidine, and Entonox on Pain Control in Burn Wound Dressing. J Burn Care Res 2021; 41:151-158. [PMID: 31630182 DOI: 10.1093/jbcr/irz142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study aimed to evaluate differences in the experience of pain, nausea, and vomiting, as well as the hemodynamic parameters including heart rate (HR) and blood pressure (BP) in burn patients across four pain treatment groups-i.e., gabapentin, ketamine, dexmedetomidine, and entonox. In a single blinded randomized comparative study, 25 burn patients with second- or third-degree burns between 20% and 50% of their body surface were assigned to different treatment groups by using block randomization, while keeping the investigator blind to the size of the block. We recorded demographics, the hemodynamics, adverse effects, and pain levels before the treatment and again 5, 10, 15, 30, 60, 120, 240, and 360 minutes postadministration of pain medication (after-treatment). Gabapentin ketamine, dexmedetomidine, and entonox had significant effects in treatment of pain in burn patients. Entonox had the best analgesic effect with the least adverse effects and hemodynamic changes. Gabapentin also had good pain management effects; however, it showed less desirable effects on hemodynamic variables. Entonox caused the least amount of hemodynamic changes and the least adverse reactions, but since the medication is delivered by a facemask it limited its application with our patients. Gabapentin offered good benefits but caused a gradual drop in BP and HR and had some unfavorable reactions. However, since it is administered orally and often is cheaper, it could be considered as the drug of choice.
Collapse
Affiliation(s)
- Simin Chaghazardi
- Injury and Pain Management Research Center, Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Hedari
- Injury and Pain Management Research Center, Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California, Los Angeles (UCLA), CA
| | - Reza Mohammadi
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Alireza Ahmadi
- Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
16
|
Young SR, Duby JJ, Louie EL, Palmieri TL. Impact of Multimodal Analgesia in Critically Ill Burn Patients. J Burn Care Res 2021; 42:986-990. [PMID: 33471091 DOI: 10.1093/jbcr/irab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Opioids are the mainstay of treatment for burn pain. However, these medications may be associated with, respiratory depression, and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and non-opioid medications with different mechanisms. This study examines the impact of multimodal therapy for post-operative pain control in a burn intensive care unit.This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% total body surface area and intensive care unit length of stay greater than seven days were eligible for inclusion (2012 - 2018). Patients were excluded if they received an opioid infusion greater than 48 hours. Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data was calculated for 5 days after surgery. There were 98 patients in the non-multimodal group and 97 in the multimodal group. . Mean cumulative opioid dose was lower in the multimodal group (1,028.7 mg vs. 1,423.2 mg, P = 0.0031). Patients with greater than 20% burns had a larger reduction in mean opioid equivalents in the multimodal group (1,106 vs 1,594 mg, P=0.009) compared to patients with burns less than 20% (940 vs. 1,282 mg, P=0.058). There was no difference in mean pain scores on post-operative day 5 (6.2 + 2.2 vs. 5.5 + 2.3 P=0.07) or at intensive care unit discharge (4.7 + 2.4 vs 4.7 + 2.8, P=0.99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control. .
Collapse
Affiliation(s)
- Sierra R Young
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Jeremiah J Duby
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Erin L Louie
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Tina L Palmieri
- Firefighters Burn Institute, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| |
Collapse
|
17
|
Romanowski KS, Carson J, Pape K, Bernal E, Sharar S, Wiechman S, Carter D, Liu YM, Nitzschke S, Bhalla P, Litt J, Przkora R, Friedman B, Popiak S, Jeng J, Ryan CM, Joe V. American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps. J Burn Care Res 2020; 41:1129-1151. [PMID: 32885244 PMCID: PMC7703676 DOI: 10.1093/jbcr/iraa119] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The ABA pain guidelines were developed 14 years ago and have not been revised despite evolution in the practice of burn care. A sub-committee of the American Burn Association's Committee on the Organization and Delivery of Burn Care was created to revise the adult pain guidelines. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords "burn pain," "treatment," and "assessment." Selected references were also used from the greater pain literature. Studies were graded by two members of the committee using Oxford Centre for Evidence-based Medicine-Levels of Evidence. We then met as a group to determine expert consensus on a variety of topics related to treating pain in burn patients. Finally, we assessed gaps in the current knowledge and determined research questions that would aid in providing better recommendations for optimal pain management of the burn patient. The literature search produced 189 papers, 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature 151 references were included, totaling 246 papers being analyzed. Following this literature review, a meeting to establish expert consensus was held and 20 guidelines established in the areas of pain assessment, opioid medications, nonopioid medications, regional anesthesia, and nonpharmacologic treatments. There is increasing research on pain management modalities, but available studies are inadequate to create a true standard of care. We call for more burn specific research into modalities for burn pain control as well as research on multimodal pain control.
Collapse
Affiliation(s)
- Kathleen S Romanowski
- University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, California
| | - Joshua Carson
- University of Florida Health Shands Burn Center, Gainesville, Florida
| | - Kate Pape
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Sam Sharar
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | - Shelley Wiechman
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | | | - Yuk Ming Liu
- Loyola University Medical Center, Maywood, Illinois
| | | | - Paul Bhalla
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | - Jeffrey Litt
- University of Missouri School of Medicine, Columbia, Missouri
| | - Rene Przkora
- University of Florida Health, Anesthesiology and Pain Medicine, Gainesville, Florida
| | | | | | - James Jeng
- Nathan Speare Regional Burn Treatment Center Crozer Chester Medical Center, Upland, Pennsylvania
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Hospitals for Children-Boston®, Boston, Massachusetts
| | - Victor Joe
- University of California Irvine Regional Burn Center, Orange, California
| |
Collapse
|
18
|
Pain Management in Burn Patients. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial. Burns 2020; 46:1571-1584. [DOI: 10.1016/j.burns.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
|
20
|
Analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds. Burns 2020; 47:880-887. [PMID: 33293157 DOI: 10.1016/j.burns.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to assess the analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds. PATIENTS AND METHODS Twenty adult patients, who underwent surgical treatment of third-degree burn wounds under general anesthesia, were included. Two of the patients underwent surgery twice. During surgery, patients received 50-100 μg fentanyl every 20-30 min and, after surgery, patients received 100 mg ketoprofen twice daily. Additionally, ten patients (group 1) received 50 μg sufentanil added to the burn wound dressings soaked in octenidine and phenoxyethanol while 10 patients (group 2) received 25 μg sufentanil added to the same dressings. The rescue analgesic, which was administered when pain intensified, was 5 mg subcutaneous morphine. Plasma sufentanil concentrations were assayed at 1, 2, 3, and 6 h after surgery completion and when pain was reported, along with pain intensity evaluation. RESULTS Sufentanil was not detected in the serum of any patients. Rescue morphine was given during the postoperative period (24 h) in one patient in group 1 (who underwent surgery twice) and three patients in group 2. The mean sufentanil concentration in dressings was higher in group 1 (0.13 ± 0.03) than group 2 (0.06 ± 0.03 μg/mL; p < 0.001). The group 1 patient who received rescue morphine had a sufentanil concentration of 0.10 μg/mL, which was the lowest concentration in group 1. Group 2 patients who received rescue morphine had sufentanil concentrations of at least two-fold lower (0.03-0.05 μg/mL). No adverse effects were observed. CONCLUSIONS Sufentanil in dressings after burn wound surgery provides effective and safe analgesia and the sufentanil concentration in dressings should be ≥0.10 μg/mL in a solution of octenidine and phenoxyethanol.
Collapse
|
21
|
Wright M, Lee JA. Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients. J Burn Care Res 2020; 41:963-966. [PMID: 32582957 DOI: 10.1093/jbcr/iraa088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).
Collapse
Affiliation(s)
- Michael Wright
- Department of Pharmacy Services, University of California, Davis
| | - Jin A Lee
- Department of Pharmacy Services, University of California, Davis
| |
Collapse
|
22
|
Concurrent validity of electronic von Frey as an assessment tool for burn associated pain. Burns 2020; 46:1328-1336. [DOI: 10.1016/j.burns.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 12/23/2022]
|
23
|
Lennertz R, Zimmerman H, McCormick T, Hetzel S, Faucher L, Gibson A. Perioperative Multimodal Analgesia Reduces Opioid Use Following Skin Grafting in Nonintubated Burn Patients. J Burn Care Res 2020; 41:1202-1206. [PMID: 32353145 DOI: 10.1093/jbcr/iraa065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hundreds of patients are treated for burn injuries each year at University of Wisconsin School of Medicine and Public Health. Pain management is particularly challenging during dressing changes and following skin grafting procedures. We performed a retrospective chart review from January 2011 through June 2018 to evaluate the effect of nonopioid analgesic medications on opioid use in nonintubated patients. Our primary outcome was the change in opioid use following the procedure. We found that most patients (69%) report severe pain (Numeric Rating Scale ≥7) immediately after autologous skin grafting. On average, patients required an additional 52 mg of oral morphine equivalents (ME) in the 24 h after the procedure compared with the 24 h before. The use of perioperative nonopioid analgesia varied between patients (acetaminophen 29%, gabapentin 29%, ketamine 35%, and all three 8%). Patients who received either gabapentin or a combination of acetaminophen, gabapentin, and ketamine had a smaller increase in their opioid use than patients who did not receive the medications (-25 ME, 95% confidence interval [-46, -4]; P = .018 and -47 ME, [-81, -11]; P = .010, respectively). These results support using a combination of acetaminophen, gabapentin, and ketamine for perioperative analgesia in burn patients undergoing autologous skin grafting.
Collapse
Affiliation(s)
| | | | | | - Scott Hetzel
- Department of Biostatistics and Medical Informatics
| | - Lee Faucher
- Department of Surgery, University of Wisconsin-Madison
| | - Angela Gibson
- Department of Surgery, University of Wisconsin-Madison
| |
Collapse
|
24
|
Goudarzi R, Nasab ME, Saffari PM, Zamanian G, Park CD, Partoazar A. Evaluation of ROCEN on Burn Wound Healing and Thermal Pain: Transforming Growth Factor-β1 Activation. INT J LOW EXTR WOUND 2020; 20:337-346. [DOI: 10.1177/1534734620915327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study aimed to evaluate the effect of liposomal arthrocen 2% (ROCEN) on the healing of burn wound and pain alleviation of thermal stimuli in a rat model of the second-degree burn. The results showed that ROCEN formulation significantly improved the main parameters of burn wound healing in a short period of time (7 days). The percentage of wound surface was also reduced significantly compared with the control group following once daily application of ROCEN for 14 days. The level of TGF (transforming growth factor)-β1 cytokine was also elevated significantly in the burn tissue treated with ROCEN almost the same as zinc oxide cream. Also, ROCEN showed a significant analgesic effect evaluated by 2 models of acute thermal pain, tail-flick and hotplate tests, which suggested that the formulation may act as a pain reliever in burn injuries. In conclusion, the application of the topical formulation of ROCEN may have benefits in the acceleration of the wound healing process and alleviation of the pain due to burn injuries.
Collapse
Affiliation(s)
- Ramin Goudarzi
- Division of Research and Development, Pharmin USA, LLC, San Jose, CA, USA
| | - Maryam Eskandary Nasab
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Partow Mirzaee Saffari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnaz Zamanian
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Chong Deok Park
- School of Pharmacy, Sungkyunkwan University, Seoul, South Korea
| | - Alireza Partoazar
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
Lima Júnior EM, De Moraes Filho MO, Costa BA, Rohleder AVP, Sales Rocha MB, Fechine FV, Forte AJ, Alves APNN, Silva Júnior FR, Martins CB, Mathor MB, de Moraes MEA. Innovative Burn Treatment Using Tilapia Skin as a Xenograft: A Phase II Randomized Controlled Trial. J Burn Care Res 2020; 41:585-592. [DOI: 10.1093/jbcr/irz205] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Skin substitutes are considered a useful alternative for occlusive dressings in the treatment of superficial burns as they reduce the frequency of dressing replacement. This phase II randomized controlled trial aimed to evaluate the efficacy of Nile tilapia (Oreochromis niloticus) skin as an occlusive xenograft dressing for the treatment of burn wounds in humans. In order to assess the use of tilapia skin, the following variables were evaluated: number of days for wound healing, the number of times the occlusive dressing was changed, use of anesthetics or analgesics, pain assessment using the Visual Analogue Scale, and evaluation of burn improvement on the day of dressing removal. In total, 62 participants completed the study. It was found that in participants treated with tilapia skin, complete reepithelialization occurred in significantly fewer days; reported pain intensity was lower (study arms B and C), the amount of anesthetics/analgesics required was lower (study arms B and C), and the necessity of dressing changes was significantly reduced in comparison with volunteers treated with silver sulfadiazine. In our study, the tilapia skin xenograft showed good efficacy as an occlusive biological dressing for burn wound treatment in humans.
Collapse
Affiliation(s)
| | - Manoel Odorico De Moraes Filho
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Bruno Almeida Costa
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Andréa Vieira Pontes Rohleder
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Marina Becker Sales Rocha
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Francisco Vagnaldo Fechine
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Antonio Jorge Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, Florida
| | | | | | - Camila Barroso Martins
- Clinical Pharmacology Unit, Drug Research and Development Center, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | | | | |
Collapse
|
26
|
Devauchelle P, Elmerich J, Laforest C, Lefort H, Jeanne M. [Management of severe burn pain]. REVUE DE L'INFIRMIÈRE 2019; 68:23-24. [PMID: 31870473 DOI: 10.1016/j.revinf.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The experience of pain during a severe burn is multifactorial, both in the typology of the burn and in the circumstances of its occurrence. Third-degree burns are painless as the dermis and its nociception sensors are damaged. After a severe burn, from initial management, to home care, to a long hospital stay, pain evolves with its etiology and requires specific management.
Collapse
Affiliation(s)
- Pauline Devauchelle
- Centre de traitement des brûlés, centre hospitalier universitaire de Lille, France
| | - Juliette Elmerich
- Centre de traitement des brûlés, centre hospitalier universitaire de Lille, France
| | - Céline Laforest
- Centre de traitement des brûlés, centre hospitalier universitaire de Lille, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, 27 avenue de Plantieres, 57077 Metz Cedex 3, France
| | - Mathieu Jeanne
- Centre de traitement des brûlés, centre hospitalier universitaire de Lille, France; Inserm, CIC 1403, centre d'investigation clinique et innovation technologique et EA 7365Bd du Professeur Jules-Leclercq, 59037 Lille, France.
| |
Collapse
|
27
|
Kim DE, Pruskowski KA, Ainsworth CR, Linsenbardt HR, Rizzo JA, Cancio LC. A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis. J Burn Care Res 2019; 40:983-995. [DOI: 10.1093/jbcr/irz111] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.
Collapse
Affiliation(s)
- Daniel E Kim
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kaitlin A Pruskowski
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Craig R Ainsworth
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| |
Collapse
|
28
|
Furness PJ, Phelan I, Babiker NT, Fehily O, Lindley SA, Thompson AR. Reducing Pain During Wound Dressings in Burn Care Using Virtual Reality: A Study of Perceived Impact and Usability With Patients and Nurses. J Burn Care Res 2019; 40:878-885. [DOI: 10.1093/jbcr/irz106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractBurns patients often suffer severe pain during interventions such as dressing changes, even with analgesia. Virtual Reality (VR) can be used to distract patients and reduce pain. However, more evidence is needed from the patients and staff using the technology about its use in clinical practice and the impact of different VR strategies. This small-scale qualitative study explored patient and staff perceptions of the impact and usability of active and passive VR during painful dressing changes. Five patients took part in three observed dressing changes—one with an active VR scenario developed for the study, one with passive VR, and one with no VR—following which they were interviewed about their experiences. Three nurses who performed the dressing changes participated in a focus group. Thematic analysis of the resulting data generated four themes: “Caution replaced by contentment,” “Distraction and implications for pain and wound care,” “Anxiety, control and enjoyment,” and “Preparation and communication concerns.” Results suggested that user-informed active VR was acceptable to burn patients, helped manage their perceived pain, and was both usable and desirable within the clinical environment. Further testing with larger samples is now required.
Collapse
Affiliation(s)
- Penny J Furness
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Ivan Phelan
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, Sheffield, UK
| | - Nathan T Babiker
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Orla Fehily
- Paediatric Psychology, Evelina London Children’s Hospital, London, UK
| | - Shirley A Lindley
- ultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, Sheffield, UK
| | | |
Collapse
|
29
|
Kneib CJ, Sibbett SH, Carrougher GJ, Muffley LA, Gibran NS, Mandell SP. The Effects of Early Neuropathic Pain Control With Gabapentin on Long-Term Chronic Pain and Itch in Burn Patients. J Burn Care Res 2019; 40:457-463. [DOI: 10.1093/jbcr/irz036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
30
|
Abstract
Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators. Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.
Collapse
Affiliation(s)
| | - Kathryn E Smith
- 1 Department of Pharmacy, Maine Medical Center, Portland, ME, USA
| |
Collapse
|
31
|
Tully A, Anderson L, Adams W, Mosier MJ. Opioid creep in burn center discharge regimens: Doubled amounts and complexity of narcotic prescriptions over seven years. Burns 2019; 45:328-334. [DOI: 10.1016/j.burns.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 07/01/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
|
32
|
Phelan I, Furness PJ, Fehily O, Thompson AR, Babiker NT, Lamb MA, Lindley SA. A Mixed-Methods Investigation Into the Acceptability, Usability, and Perceived Effectiveness of Active and Passive Virtual Reality Scenarios in Managing Pain Under Experimental Conditions. J Burn Care Res 2018; 40:85-90. [DOI: 10.1093/jbcr/iry052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ivan Phelan
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, UK
| | - Penny J Furness
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, UK
| | - Orla Fehily
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Nathan T Babiker
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Martin A Lamb
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, UK
| | - Shirley A Lindley
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, UK
| |
Collapse
|
33
|
Sasaki K, Mutoh T, Shiga T, Gómez de Segura IÁ. Successful intensive management in dogs with postoperative cutaneous drug hypersensitivity. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kazumasu Sasaki
- Small Animal Emergency and Critical Care ServiceSendai Animal Care and Research CenterSendaiJapan
- Tohoku UniversitySendaiJapan
| | | | | | | |
Collapse
|
34
|
Pain and itch outcome trajectories differ among European American and African American survivors of major thermal burn injury. Pain 2018; 158:2268-2276. [PMID: 28796116 DOI: 10.1097/j.pain.0000000000001029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than half of individuals experiencing major thermal burn injury (MThBI) receive an autologous skin graft (autograft), in which skin is removed from a healthy "donor" site and transplanted to the burn site. Persistent pain and itch at the graft site are major causes of suffering and disability in MThBI survivors. African Americans have a higher risk of MThBI, and in other clinical settings African Americans experience a greater burden of pain and itch relative to European Americans. However, to our knowledge, ethnic differences in skin graft site pain and itch outcomes after MThBI have not been assessed. We evaluated skin graft site pain and itch severity (0-10 Numeric Rating Scale [NRS]) over 1 year in a prospective multicenter cohort sample of African Americans and European Americans. In adjusted linear mixed models, African Americans experienced a slower rate of pain resolution in the acute phase of recovery (β = -0.05 vs -0.08 NRS points per day, P < 0.001), which resulted in a higher pain severity in the persistent phase of recovery (NRS mean difference = 1.21, 95% confidence interval [0.12-2.29]), although not statistically significant after correction for multiple comparisons. African Americans also experience greater itch severity in 6 weeks to 12 months after burn injury compared with European Americans (NRS mean difference = 1.86 [0.80-2.93]), which results from a faster rate of itch development in African Americans in the acute recovery phase after burn injury. Future studies may improve outcomes in African Americans and lead to new pathogenic insights that benefit all burn injury survivors.
Collapse
|
35
|
Khadra C, Ballard A, Déry J, Paquin D, Fortin JS, Perreault I, Labbe DR, Hoffman HG, Bouchard S, LeMay S. Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: a pilot study. J Pain Res 2018; 11:343-353. [PMID: 29491717 PMCID: PMC5817417 DOI: 10.2147/jpr.s151084] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care. AIM We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management. METHODS From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal. Each child received the projector-based VR intervention in addition to the standard pharmacological treatment. Data on intervention and study feasibility and acceptability in addition to measures on pain (Face, Legs, Activity, Cry, Consolability scale), baseline (Modified Smith Scale) and procedural (Procedure Behavior Check List) anxiety, comfort (OCCEB-BECCO [behavioral observational scale of comfort level for child burn victims]), and sedation (Ramsay Sedation Scale) were collected before, during, and after the procedure. Data analyses included descriptive and non-parametric inferential statistics. RESULTS We recruited 15 children with a mean age of 2.2±2.1 years and a mean total body surface area of 5% (±4). Mean pain score during the procedure was low (2.9/10, ±3), as was the discomfort level (2.9/10, ±2.8). Most children were cooperative, oriented, and calm. Assessing anxiety was not feasible with our sample of participants. The prototype did not interfere with the procedure and was considered useful for procedural pain management by most health care professionals. CONCLUSION The projector-based VR is a feasible and acceptable intervention for procedural pain management in young children with burn injuries. A larger trial with a control group is required to assess its efficacy.
Collapse
Affiliation(s)
- Christelle Khadra
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - Ariane Ballard
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - Johanne Déry
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Direction of Nursing, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - David Paquin
- Department in Creation and New Media, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | | | - Isabelle Perreault
- Department of Surgery, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - David R Labbe
- Department of Software and IT Engineering, École de Technologie Supérieure, Montreal, QC, Canada
| | - Hunter G Hoffman
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Sylvie LeMay
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| |
Collapse
|
36
|
Herlihy CR, Barry C. Anesthesia and Burns. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Kubota T, Ishikawa Y, Ishikawa R. Spinal Cord Stimulation Treatment for Persistent Pain After a Burn Injury: A Case Report. ACTA ACUST UNITED AC 2017; 9:35-37. [PMID: 28306581 DOI: 10.1213/xaa.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spinal cord stimulation (SCS) is used to treat neuropathic pain, but there are no published studies on its use to treat burn pain. We used SCS to treat a 67-year-old man suffering from burn pain that could not be managed with high-dose opioids or adjuvant neuropathic analgesics. A trial of SCS markedly reduced the visual analog scale score for pain in the left lateral abdominal and gluteal regions. He underwent permanent implantation of a SCS and achieved an opioid-free state. This case suggests that SCS treatment is a therapeutic option for burn pain refractory to conventional therapy.
Collapse
Affiliation(s)
- Takeshi Kubota
- From the Department of Anesthesia, Hachinohe Heiwa Hospital, Hachinohe, Japan
| | | | | |
Collapse
|
38
|
Role of the NLRP3 inflammasome in a model of acute burn-induced pain. Burns 2017; 43:304-309. [DOI: 10.1016/j.burns.2016.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 12/28/2022]
|
39
|
|
40
|
Bitter CC, Erickson TB. Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings. Wilderness Environ Med 2016; 27:519-525. [DOI: 10.1016/j.wem.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/27/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023]
|
41
|
Yin K, Deuis JR, Lewis RJ, Vetter I. Transcriptomic and behavioural characterisation of a mouse model of burn pain identify the cholecystokinin 2 receptor as an analgesic target. Mol Pain 2016; 12:12/0/1744806916665366. [PMID: 27573516 PMCID: PMC5007901 DOI: 10.1177/1744806916665366] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/22/2016] [Indexed: 12/23/2022] Open
Abstract
Burn injury is a cause of significant mortality and morbidity worldwide and is frequently associated with severe and long-lasting pain that remains difficult to manage throughout recovery. We characterised a mouse model of burn-induced pain using pharmacological and transcriptomic approaches. Mechanical allodynia elicited by burn injury was partially reversed by meloxicam (5 mg/kg), gabapentin (100 mg/kg) and oxycodone (3 and 10 mg/kg), while thermal allodynia and gait abnormalities were only significantly improved by amitriptyline (3 mg/kg) and oxycodone (10 mg/kg). The need for relatively high opioid doses to elicit analgesia suggested a degree of opioid resistance, similar to that shown clinically in burn patients. We thus assessed the gene expression changes in dorsal root ganglion neurons and pathophysiological mechanisms underpinning burn injury-induced pain using a transcriptomic approach. Burn injury was associated with significantly increased expression of genes associated with axon guidance, neuropeptide signalling, behavioural defence response and extracellular signalling, confirming a mixed neuropathic and inflammatory aetiology. Notably, among the pain-related genes that were upregulated post-injury was the cholecystokinin 2 receptor (Cckbr), a G protein-coupled receptor known as a pain target involved in reducing opioid effectiveness. Indeed, the clinically used cholecystokinin receptor antagonist proglumide (30 mg/kg) was effective at reversing mechanical allodynia, with additional analgesia evident in combination with low-dose oxycodone (1 mg/kg), including significant reversal of thermal allodynia. These findings highlight the complex pathophysiological mechanisms underpinning burn injury-induced pain and suggest that cholecystokinin-2 receptor antagonists may be useful clinically as adjuvants to decrease opioid requirements and improve analgesic management.
Collapse
Affiliation(s)
- Kathleen Yin
- Centre for Pain Research, Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Jennifer R Deuis
- Centre for Pain Research, Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Richard J Lewis
- Centre for Pain Research, Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Irina Vetter
- Centre for Pain Research, Institute for Molecular Bioscience, University of Queensland, Queensland, Australia Pharmacy Australia Centre of Excellence, University of Queensland, Queensland, Australia
| |
Collapse
|
42
|
Green D, Ruparel S, Gao X, Ruparel N, Patil M, Akopian A, Hargreaves K. Central activation of TRPV1 and TRPA1 by novel endogenous agonists contributes to mechanical allodynia and thermal hyperalgesia after burn injury. Mol Pain 2016; 12:12/0/1744806916661725. [PMID: 27411353 PMCID: PMC4955965 DOI: 10.1177/1744806916661725] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The primary complaint of burn victims is an intense, often devastating spontaneous pain, with persistence of mechanical and thermal allodynia. The transient receptor potential channels, TRPV1 and TRPA1, are expressed by a subset of nociceptive sensory neurons and contribute to inflammatory hypersensitivity. Although their function in the periphery is well known, a role for these TRP channels in central pain mechanisms is less well defined. Lipid agonists of TRPV1 are released from peripheral tissues via enzymatic oxidation after burn injury; however, it is not known if burn injury triggers the release of oxidized lipids in the spinal cord. Accordingly, we evaluated whether burn injury evoked the central release of oxidized lipids. Analysis of lipid extracts of spinal cord tissue with HPLC-MS revealed a significant increase in levels of the epoxide and diol metabolites of linoleic acid: 9,10-DiHOME, 12,13-DiHOME, 9(10)-EpOME, and 12(13)-EpOME, that was reduced after intrathecal (i.t.) injection of the oxidative enzyme inhibitor ketoconazole. Moreover, we found that these four lipid metabolites were capable of specifically activating both TRPV1 and TRPA1. Intrathecal injection of specific antagonists to TRPV1 (AMG-517) or TRPA1 (HC-030031) significantly reduced post-burn mechanical and thermal allodynia. Finally, i.t. injection of ketoconazole significantly reversed post-burn mechanical and thermal allodynia. Our data indicate that spinal cord TRPV1 and TRPA1 contributes to pain after burn and identifies a novel class of oxidized lipids elevated in the spinal cord after burn injury. Since the management of burn pain is problematic, these findings point to a novel approach for treating post-burn pain.
Collapse
Affiliation(s)
- Dustin Green
- University of Texas Health Science Center at San Antonio
| | | | - Xiaoli Gao
- University of Texas Health Science Center at San Antonio
| | - Nikita Ruparel
- University of Texas Health Science Center at San Antonio
| | - Mayur Patil
- University of Texas Health Science Center at San Antonio
| | - Armen Akopian
- University of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San Antonio
| | | |
Collapse
|
43
|
Small C, Stone R, Pilsbury J, Bowden M, Bion J. Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial. Trials 2015; 16:329. [PMID: 26242401 PMCID: PMC4526294 DOI: 10.1186/s13063-015-0878-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/17/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients' psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system. METHODS/DESIGN The present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system's impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions: 1. Interactive VRET plus conventional analgesics. 2. Passive VRET with conventional analgesics. 3. Conventional analgesics alone. Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes. DISCUSSION The study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable. TRIAL REGISTRATION Current Controlled Trials ISRCTN23330756 . Date of Registration 25 February 2014.
Collapse
Affiliation(s)
- Charlotte Small
- School of Clinical and Experimental Medicine, The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Robert Stone
- School of Electronic, Electrical and Systems Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Jane Pilsbury
- Anaesthetic Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, B15 2WB, UK.
| | - Michael Bowden
- Anaesthetic Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, B15 2WB, UK.
| | - Julian Bion
- The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK.
| |
Collapse
|