D. Patterson, Ph.D.; S R. Sharar, MD; D. Heimbach, MD., J Doctor, Ph.D.
The primary long term objective of this project is to improve pain control and reduce resulting disability in all age groups of burn survivors (e.g., pediatric, adult, and elderly). This will be accomplished by determining the optimal combinations of Opioid analgesics, anxiolytics and psychological approaches, and matching treatments with patient characteristics that may predict thrapeutic effects. Because extensive burn injuries are clearly an etiology of acute pain that produce substantial challenges in its treatment, the results will be generalizable to other causes of pain. A second primary objective will be to determine how pain and other factors related to burn injuries influence long term physical and psychological adjustment. To accomplish these objectives, the investigators will conduct six studies, of which four have randomized, controlled designs, one has an observational methodology and one uses longitudinal measurement. These studies will specifically 1) investigate the synergistic effects of a benzodiasipine (lorzepam) and a psychological technique (hypnosis) in reducing burn pain and stress level, relative to the individual use of such techniques, as well as opioid analgesics alone and 1a) introduce and test a new set of variables for their ability to predict the analgesic effects of the modalities used (e.g. Opioid analgesic, lorazepam, hypnosis, virtual reality), 2 provide the first controlled study of the use of virtual reality in reducing pain from skin graft dressing changes, 3) continue previous studies in order to gain a large enough sample to determine the effects that opioid pain medication scheduling has on acute pain levels in pediatric patients, 4) continue with previous studies in order to produce the first controlled pediatric burn pain study comparing the use of anxiolytics and Opioid analgesics, 5) perform the first even prospective analyses of the Opioid analgesic needs of elderly burn patients, and 6) test a predictive model for determining the longitudinal impact of burn injuries on psychological adjustment and health outcome. The anticipated benefits of this project will be that they will provide information enabling health care professionals to treat acute pain more effectively across the life span. This will not only reduce unnecessary suffering, but might improve health outcomes by minimizing the deleterious effects of acute pain.