Little is known as to how effective optimal doses of narcotic drugs are in treating pain in patients hospitalized for the treatment of severe burns. Adjunctive pain control interventions such as minor tranquilizers and psychological techniques often supplement opioid drugs, but data on their efficacy is sparse. Further, it remains to be seen what the effect that pain levels in hospitalized patients has on their long term functional outcome. The first general aim of this project is to assess the analgesic efficacy of routine narcotic use on this population and to test the ability of commonly used pharmacologic (i.e., anxiolytic drugs) and psychologic (i.e., hypnosis) adjunctive interventions in affecting this dimension of burn patient care. A particular emphasis will be on delineating factors which predict which treatment will be the most helpful with which patient.
The second aim will be to investigate how pain reports during hospitalization affect burn patients' post discharge functional capacity as measured by self report at one and twelve month follow-up. Two studies will be conducted to accomplish these aims. In the first study, subjects will be randomly assigned to narcotic only, narcotic plus anxiolytic or narcotic plus hypnosis treatment groups (independent variables) and differences in their ratings on pain, depression and anxiety scores (dependent variables) will be analyzed. Potential predictive measures (e.g., trait anxiety, fear of surgery, post-traumatic stress, pre- injury mental health) will be obtained on hospitalized burn patients who meet the study criteria, and their pain reports will then be followed for 11 consecutive dressing changes. In the second study, burn patients' functional capacity as measured by self report at 1 and 12 month follow-up will be compared for those who rated their pain as high or low during hospitalization.
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