Pain Control and Psychological Outcome
By: David R. Patterson, Ph.D, ABPP, ABPH

At the University of Washington Burn Center, we have been conducting
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Translations
research on pain control and psychological outcome with

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patients who have sustained major burn injuries for over a decade. Most of this research has been sponsored by the National Institutes of Health. There are several major findings that have come out of this line of research. First of all, we have found in a series of randomized, controlled studies that hypnosis is useful in reducing pain during dressing changes, particularly in those patients who are hurting the most. Secondly, we have found in controlled studies that adding a tranquilizer (lorazepam) to pain medication during painful dressing changes reduces patients' ratings of pain. Finally, we have reported that patients (usually children) are able to tolerate physical therapy and wound care pain better when they are distracted by entering a virtual reality induced world. At the University of
Washington, we are strong advocates of using morphine and other powerful drugs to control burn pain. Our research demonstrates however that such drugs do not control all burn pain and such additional treatments as hypnosis, tranquilizers and virtual reality can be very effective in lessening this type of pain.

Interestingly, we have found that the amount of pain patients experience during hospitalization is one of the biggest predictors of how they adjust psychologically. For some patients, the amount of pain they feel is more important than the size of their burn, the location of the injury or how long they spend in the hospital.

In our psychological outcome studies we have found that about 20% of patients show post-traumatic stress disorder after their burn injuries and a greater number show mild to moderate levels of depression. We have not found, however, that we can determine who will have psychological problems based on the type of burn they sustain. Rather, it is more important to look at who the person that was burned is (for example how they coped with problems before they were burned) and what type of social support they have. Sleep and pain are often problems that are neglected with this patient population and we have a great deal to work to do on measuring and improving survivors' satisfaction with their appearance.

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