[Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in children with burns: a prospective randomized controlled study]
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Insights
Stepwise acute pain management effectively reduced pain and post-traumatic stress disorder (PTSD) incidence in pediatric burn patients. This approach offers a better alternative for managing acute pain and psychological distress in children with burns.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Trauma Psychology
Background:
- Acute pain and post-traumatic stress disorder (PTSD) are significant challenges in pediatric burn management.
- Effective pain control is crucial for improving patient outcomes and reducing long-term psychological sequelae.
- Traditional pain management strategies may not always adequately address the complex needs of children with burns.
Purpose of the Study:
- To evaluate the efficacy of a stepwise acute pain management protocol compared to traditional care in pediatric burn patients.
- To assess the impact of stepwise pain management on reducing acute pain levels.
- To determine the effect of stepwise pain management on the incidence of PTSD in children with burns.
Main Methods:
- A prospective randomized controlled study involving 196 pediatric burn patients (aged 1-6 years).
- Patients were assigned to either traditional pain management or a stepwise approach involving acetaminophen and morphine as needed.
- Pain levels were assessed using the COMFORT behavior scale, and PTSD incidence was evaluated using the revised PTSD scale within one month post-injury.
Main Results:
- The stepwise pain management group exhibited significantly lower pain scores compared to the traditional group across multiple assessment points within the first three post-injury days (P<0.05 or P<0.01).
- No adverse reactions were reported in the stepwise pain management group.
- The incidence of PTSD was significantly lower in the stepwise group (3.12%) versus the traditional group (14.43%) (P<0.05).
Conclusions:
- Stepwise acute pain management is effective in alleviating acute pain in children with burns.
- This management strategy significantly reduces the incidence of post-traumatic stress disorder (PTSD) in pediatric burn patients.
- Stepwise pain management represents an improved approach for managing acute pain and preventing PTSD in pediatric burn populations.
Abstract:
Objective: To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in children with burns. Methods: From November 2018 to December 2019, 196 children with burns who were admitted to West China Hospital of Sichuan University and met the inclusion criteria were enrolled in the prospective randomized controlled study. The children were divided into traditional pain management group (97 children, 51 males and 46 females, aged 1 to 6 years) and stepwise pain management group (96 children, 55 males and 41 females, aged 1 to 6 years) according to the random number table. Children in traditional pain management group were treated with traditional acute pain care, while the children in stepwise pain management group were treated with stepped acute pain management (moderate pain was treated with oral administration of acetaminophen sustained-release dry suspension at the dose of 10 to 15 mg/kg once every 4 to 6 hours, and severe pain was treated with morphine intravenous injection at the dose of 0.1 to 0.2 mg/kg once every 4 hours) on the basis of traditional acute pain care after admission. The COMFORT behavior scale was applied to compare the resting pain levels of children in the two groups within post injury day (PID) 3 (1, 9, and 17 o'clock each day). The adverse reactions of children in the stepwise pain management group during the treatment period were recorded. The occurrence of PTSD within one month after injury was evaluated in both groups by the revised PTSD scale. Data were statistically analyzed with independent sample t test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. Results: The pain scores of children in stepwise pain management group were significantly lower than traditional pain management group at 1, 9, and 17 o'clock on PID 1, 1, 9, and 17 o'clock on PID 2, and 1, 9, and 17 o'clock on PID 3 (t=2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71, P<0.05 or P<0.01). The pain scores of children in both groups showed a decreasing trend over time. Of the 96 children in stepwise pain management group, 84 children were treated with oral administration of acetaminophen sustained-release dry suspension, and 12 children were treated with morphine intravenous injection. No adverse reaction occurred during the treatment period. The incidence of PTSD of children in stepwise pain management group within 1 month after injury was 3.12% (3/96), which was significantly lower than 14.43% (14/97) in traditional pain management group, P<0.05. Conclusions: The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in children with burns.
