Study / Main Purpose / Research Design / Sample / Outcome
Measures / Results / Study Category / Level of Evidence
Aaron,
2001176 / To evaluate the ability of the abbreviated five-item Burn Specific Pain Anxiety Scale (BSPAS) to predict procedural pain, medication usage, and physical function at discharge. / Short-term prospective cohort. / 27 adult patients. 89% male. Mean TBSA 11%. / Abbreviated Burn Specific Pain Anxiety Scale (BSPAS), State Anxiety Inventory (STAI), Profile of Mood States (POMS) tension-anxiety subscale, and Short-Form Health Survey (SF-36). / BSPAS predicted procedural pain (r = .40), background pain (r = .32), total pain medications (r = .43) and several SF-36 subscales after controlling for TBSA and with STAI and POMS anxiety included in stepwise regression. / Diagnostic / IV
Byers, 2001180 / To examine burn patients’ pain and anxiety experiences during resting conditions and procedures. / Short-term prospective cohort. / 23 adult patients. 91% male. Mean TBSA not reported. 91% with only partial thickness burns and 9% with areas of full-thickness burns. /
VAS and Short-form McGill Pain Questionnaire.
/ All pain measures were significantly higher during procedures than during rest. Anxiety and affective pain were not significantly different between procedures and background. / Diagnostic / IVChoiniere, 1989177 / To examine the characteristics of pain experienced by burn patients. / Short-term prospective cohort. / 42 adult patients from 2 hospitals. 81% male. Mean TBSA 15%. /
VAS, McGill Pain Questionnaire, State-Anxiety Inventory, Beck Depression Inventory – Short Form.
/ 63% reported immediate pain onset with injury, 37% delayed. Pain during procedures more intense than during rest. Pain varied considerably from patient to patient and within patients across time with gradual reduction towards end of hospitalization. Pain initially predicted by TBSA. Pain not predicted by demographic or socioeconomic variables. / DiagnosticPrognostic / IV
Choiniere, 1991152 / To document the prevalence and characteristics of pain and paresthesia problems in a group of patients with healed burns. / Retrospective cohort. / 104 burn survivors 1-7 years post-burn (mean 37 months). 76% male. Mean TBSA 19%. /
Structured telephone interview with questions about current pain and clinical condition of healed wounds.
/ 36 (35%) reported pain in the healed burns (present every day in 58% and intermittent in 42%). TBSA and grafts predicted chronic pain. / DiagnosisPrognostic / IV
Choiniere, 1994174 / To assess the psychometric characteristics of the visual analogue thermometer (VAT). / Cross-sectional with self-ratings by patients and observer ratings by nurses. / 103 adult patients. 66% male. Median TBSA 15%. /
Visual analogue thermometer, numeric scale for pain, and adjective scale for pain.
/ High convergent validity between 3 assessment methods. Good sensitivity to treatment. / Diagnostic / IIIDas,
2005203 / To test immersive virtual reality (VR) as a tool for pain management with children. / Case series. Within-subject control. Patients were treated with VR for half of dressing change and without VR during the other half. / 9 pediatric patients ages 5-16 years old. Mean age 10. Mean TBSA 5%. /
Modified self-report Faces pain scale.
/ Mean pain scores over all trials was significantly lower for VR condition with large effect size. / Therapeutic / IVDauber, 2002181 / To determine the prevalence, characteristics, and effects of chronic, persistent pain on burn survivors. / Cross-sectional survey. / 358 members of Phoenix Society survivors group. 53% male. Mean 3rd degree burns 38%, mean 2nd degree burns 22%. Mean time since injury 13 years. /
Questionnaire on demographic, burn and treatment information, and pain, McGill Pain Questionnaire-Short Form.
/ 52% still had ongoing pain (79% of these from burn, 21% as result of ongoing burn-related treatment). / Diagnosis / IVField, 1998202 / To test effect of massage therapy before debridement as compared to standard care to reduce pain, anxiety, depressed mood state, and stress hormones over 1 week. / Randomized controlled trial with patients assigned to massage or control group. / 28 adult patients. 86% male. Mean TBSA 10%. /
State Anxiety Inventory, McGill Pain Questionnaire, Present Pain Intensity Scale, VAS, Profile of Mood States, pulse rates and salivary cortisol.
/ Pain, depression, and anger improved significantly for massage group from baseline to 1-wk as compared to control group. / Therapeutic / IVField, 2000151 / To determine the effect of 30-minute massage therapy 2x per week for 5 weeks on the reduction of postburn itching and pain. / Randomized controlled trial with patients assigned to massage therapy or control group. / 20 adult patients. 70% male. Mean TBSA 12%. /
VAS itching, McGill Pain Questionnaire, State-Trait Anxiety Inventory, Profile of Mood States.
/Significant reduction in pain over 5-week treatment period for massage group as compared to control group.
/ Therapeutic / IVFinn, 2004188 / Comparison of intranasal fentanyl and oral morphine for procedural pain. / Randomized, double-blind placebo controlled, crossover design. Group A received intranasal fentanyl and oral placebo on day one and intranasal placebo and oral morphine on day 2. The sequence in group B was reversed. / 26 patients of average age 35.5 years, randomly assigned to one of 2 treatment protocols. / Patient rating of pain intensity on a Numeric Rating Scale (0-10) at 6 time points during wound care procedure. / No significant difference in pain scores during the procedure with intranasal fentanyl compared to oral morphine. / Therapeutic / III
Frenay, 2001196 / To compare hypnosis to a treatment that combined several stress reducing strategies in controlling pain and anxiety before, during, and after dressing changes. / Randomized controlled trial with patients assigned to hypnosis group or stress reducing strategies (SRS) group. Measurement on days 1, 3, 5, 7, 8, 10, 12, 14. Intervention on days 8, 10. / 26 adult patients. 50% male. Hypnosis group: 61% male, mean TBSA 19%.
SRS group: 33% male, mean TBSA 17%. / VAS for anxiety, pain, control of pain. / Reported significant differences in anxiety before and during wound care with hypnosis group less anxious. No other significant differences reported. / Therapeutic / IV
Gallagher, 2000190 / To determine the efficacy and safety of patient controlled analgesia with fentanyl. / Case series. / 10 adult patients undergoing wound care/dressing changes. Subjects blinded to drug infusion rate. / Visual analog scale (VAS) for assessment of pain at baseline and during the procedure. Sedation scores (0-3 scores). / No sedation in any of the subjects and adequate pain relief. Study supported the efficacy of PCA anlagesia with fentanyl. / Therapeutic / IV
Hansen, 2001192 / To determine the effectiveness of intranasal midaxolam (Versad) (INM). / Retrospective, chart review. / 12 patients less than 9 years of age who had received INM during their hospitalization. Patients received other pain medications. / Documented nursing assessment of pain control as poor, fair or good. / No statistical analysis completed, but use of INM appears to be comparable to use of other oral or intravenous pain medications. / Therapeutic / IV
Harandi, 2004198 / To evaluate the efficacy of hypnotherapy in reducing pain and anxiety during physical therapy. / Randomized controlled trial with patients assigned to hypnotherapy or no intervention group. / 44 Iranian female patients. Mean TBSA 29%. / VAS for procedural pain and anxiety. / Reported significant differences in reduction of procedural pain and anxiety over 4 sessions for hypnotherapy as compared to no intervention group.
/ Therapeutic / IV
Haythornthwaite, 2001182 / To test the efficacy of 2 brief cognitive interventions in supplementing regular medical treatment for pain during burn dressing change. / Randomized controlled trial with patients assigned to one of 3 treatment groups (sensory focus, distraction, usual care). / 42 adult patients (14 per group). 76% male. Mean TBSA 16%. / VAS pain, Burn Related Coping Strategies Questionnaire, Beck Depression Inventory. / No effects of group on real-time ratings of peak and average pain or retrospective ratings of average pain, peak pain, satisfaction with pain control. Catastrophizing was a significant predictor of pain after controlling for TBSA, sex, depression across study groups. / Therapeutic
Prognosis / IV
Hoffman, 2000194 / To test immersive virtual reality (VR) as a distraction technique for pain management during physical therapy. / Case series. Within-subject control. Patients were treated during one physical therapy session only in the study, 3 minutes with VR and 3 minutes without VR. / 12 adult patients. 92% male. Mean TBSA 21%. /
VAS for time thinking about pain, worst pain, average pain, bothersomeness of pain, unpleasantness of physical therapy, anxiety at conclusion of each segment.
/VR performed significantly better than the control condition for all outcome measures with very large effect sizes.
/ Therapeutic / IIIHoffman, 2000199 / To test immersive virtual reality (VR) as a non-opioid analgesic during wound care against a video game control condition. / Case report, within-subjects control (A-B, B-A), Patients had VR for 3 minutes and video game for 3 minutes during session (2 sessions for patient #1, 1 session for patient #2). / Patient #1 was a 16-year-old male with 5% TBSA deep flame/flash gasoline burn to lower right leg, had grafting. Patient #2 was a 17-year-old male, 34% TBSA with deep flash burns to face, chest, back, stomach, upper legs, right arm, had grafting. /
VAS for worst pain, average pain, anxiety, unpleasantness of wound care, time spent thinking about pain, and how much wound bothered patient.
/Both patients showed substantial reductions of over 50% across pain measurements with immersive VR as compared to video game condition.
/ Therapeutic / IVHoffman, 2001195 / To explore whether immersive virtual reality (VR) continues to reduce pain (via distraction) with repeated use. / Case series, within subject control. Patients performed range of motion exercises on injured extremity on at least 3 days. On each day, the patients spent 3 minutes each in VR and control (no VR) conditions. / 7 children and adults. 86% male. Mean TBSA 24%. Mean age 22 years old (range 9 to 32). /
VAS for worst pain, average pain, anxiety, unpleasantness of wound care, time spent thinking about pain, and how much wound bothered patient.
/Therapeutic: On each of 3 days, patients reported significantly reduced scores on all outcome variables during VR portion of physical therapy as compared to no VR control portion.
/ Therapeutic / IIIHoffman, 2004200 / To describe the use of water-friendly virtual reality (VR) technology in wound care. / Case study. Patient 3-minutes with VR and 3-minutes with no distraction during wound care. / Patient was a 40-year-old male with 19% TBSA deep flame/flash burns to leg, back, and buttocks. /
VAS for worst pain, unpleasantness, amount of time thinking about pain.
/ VR was more effective than no-distraction for worst pain (decrease from 7 to 2), unpleasantness (6 to 3), and time spent (all the time to some of the time). / Therapeutic / IVLinneman, 2000191 / Determine the effectiveness of fentanyl for treatment of burn pain. / Retrospective chart review. / 55 patients aged 9 months to 75 years who received 148 doses of intravenous fentanyl with an average first dose of 8 microgram/kg. / Fentanyl dose, patient assessment of pain on 0 to 10 scale. / 85% with adequate pain control (pain score of <5). No correlation with percent TBSA burned and fentanyl dose. Transient respiratory depression seen in 17 patients (31%). / Therapeutic / IV
Long,
2001189 / Examine the effectiveness of morphine-infused silver sulfadiazine (MISS) cream on pain. / Double-blind, placebo controlled study. Subjects treated with MISS cream or placebo. / 4 patients who received the MISS cream or placebo for 4 days with dressing changes. / Brief Pain Inventory, Opiod Side Effects Questionnaire. / Statistical analysis not possible due to small sample size. / Therapeutic / IV
Malenfant, 1996153 / To examine the prevalence and characteristics of chronic sensory problems 1 year or more postburn. / Cross-sectional. / 236 burn survivors 1-7 years post-burn. 76% male. Mean TBSA 20%. Mean time since injury 47 months (range 12-102 months). /
Modified version of Choiniere et al.’s (1991)68 structured interview protocol about paresthetic and painful sensations, VAS pain, McGill Pain Questionnaire.
/36% of sample with chronic pain. No relationships were found between sensory problems and the patients' age or sex, burn etiology, or length of time elapsed since injury. Burn severity was related to the frequency of the problems.
/ DiagnosticPrognostic / III
Patterson, 1997184 / To examine the analgesic effect of lorazepam. / Randomized double-blinded study. Patients admitted to burn center received usual opiate pain treatment. Subjects randomized to receive 1 mg of lorazepam orally or placebo before wound care. Study conducted over a 4-day period. / 79 adult patients treated at the burn center. / Visual analog scale (VAS) for assessment of pain. Standard assessment measure of anxiety. / No significant analgesic effect between the treatment groups. In an analysis of subjects who had a high level of baseline pain there was a significant reduction in pain ratings in the lorazepam group. / Therapeutic / II
Patterson, 1997193 / To test efficacy of hypnosis for pain relief of procedural pain. / Randomized controlled trial with patients assigned to hypnotic analgesia group or control condition in which they received information and brief relaxation instructions. / 61 adult patients. 84% male. Mean TBSA 14%. /
VAS for worst pain during debridement.