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The assessment of pain and plasma beta-endorphin immunoactivity in burned children
S K Szyfelbein1, Patricia F Osgood, Daniel B Carr
1Anesthesia Services of the Massachusetts General Hospital and Shriners Burns Institute, Boston, MA 02114, Department of Anesthesia, Harvard Medical School, Boston, MA, U.S.A. Endocrinology Unit, Massachusetts General Hospital, Boston, MA 02114 U.S.A.
Insights
Pain during burn dressing changes (BDCs) in children was assessed using a pain scale and beta-endorphin levels. Higher pain scores correlated with lower beta-endorphin levels and larger burn extent.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Endocrinology
Background:
- Burn dressing changes (BDCs) are acutely painful for children.
- Effective analgesia during BDCs is crucial for pediatric burn patients.
- Existing pain assessment methods may not fully capture pain intensity.
Purpose of the Study:
- To assess pain experienced by children during BDCs.
- To investigate the relationship between pain scores and plasma beta-endorphin levels.
- To explore factors influencing pain intensity during BDCs.
Main Methods:
- Utilized a 0-10 thermometer-like scale for pain assessment during 33 BDCs in 15 pediatric patients (8-17 years).
- Measured plasma beta-endorphin immunoactivity (iB-EP) at five intervals before and after BDCs.
- Correlated mean pain scores (MPS) with iB-EP levels and patient factors (burn extent, weight).
Main Results:
- The pain scale was well-accepted and reflected varying pain degrees.
- Mean iB-EP levels decreased from 30.5 pg/ml before BDC to 19.2 pg/ml immediately after.
- MPS was inversely related to iB-EP levels (P < 0.001) and directly related to burn extent, inversely to weight.
Conclusions:
- Pain during BDCs in children is significant and measurable.
- Plasma beta-endorphin levels appear to be inversely correlated with perceived pain intensity.
- Burn extent and patient weight are also significant predictors of pain during BDCs.
Abstract:
The need for better analgesia during burn dressing changes (BDCs) in acutely burned children led us to assess pain during BDC with a large 0-10 thermometer-like scale which was well accepted and appeared to reflect the varying degrees of pain that patients experienced. Pain scores were obtained at least once each minute throughout 33 BDCs in 15 patients of 8-17 years. Plasma levels of beta-endorphin immunoactivity (iB-EP) were measured at 5 intervals before and after BDC; mean values (+/- S.E.M.) ranged from 30.5 +/- 4.63 pg/ml (before BDC and analgesic) to 19.2 +/- 3.02 pg/ml (immediately following BDC). The mean pain score (MPS) for each BDC was inversely related to the iB-EP levels of that day (P less than 0.001 with 4 of the 5 iB-EP determinations). The MPS varied directly with the extent of burn injury and inversely with weight; the 2 variables together predicted MPS as well as the iB-EP alone (r2 = 43 and 36% respectively).