Results of a Pilot Multicenter Genotype-based Randomized Placebo-controlled Trial of Propranolol to Reduce Pain After Major Thermal Burn Injury

Abstract

Background Results of previous studies suggest that β-adrenoreceptor activation may augment pain, and that β-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high activity haplotype. Methods Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high activity COMT homozygotes were randomized to propranolol 240mg/day or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5-19. Secondary outcomes assessed pain and posttraumatic stress disorder (PTSD) symptoms 6 weeks post-injury. Results Seventy-seven (61/79) percent of eligible patients were consented and genotyped, and 77% (47/61) were genotype-eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention to treat and per protocol analyses, patients randomized to propranolol had worse pain scores on study days 5-19. Conclusions Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

“…49 Published studies of analgesics, electromagnetic therapy, and acupuncture to reduce persistent pain after MVC are too small to be conclusive. 50-52 Teaching pain coping skills, 53,54 treatment with novel therapeutic agents, 55,56 or using cognitive behavioral therapy to reduce depressive or pain catastrophizing symptoms 10 may have utility in this population. More work is needed to develop and test interventions such as these in the vulnerable and growing population of older adults experiencing MVC.…”

The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

“…9,24,25 The latest meta-analysis 9 included eight studies in quantitative synthesis and indicated that there were no differences in mortality or sepsis, while the use of propranolol in burned patients resulted in lower values of HR. As a few new RCTs [10][11][12][13][14][15][16][17][18][19][20][21] have been reported recently, we conducted this systematic review and metaanalysis to evaluate the effectiveness and safety of beta blocker in burned patients. We further confirmed that the use of beta antagonist in burned patients has no significant effect on sepsis and mortality and reduced HR.…”

“…According to the current research results, early identification and control of psychological problems such as anxiety or depression helps accelerate the process of wound healing. 32,33 Orrey et al 10,18,19 used the PSS-I criteria 34 to determine PTSD, while ASD was measured by the "acute stress disorder symptom checklist." 35 Our results have shown that the occurrence of stress events such as PTSD and ASD in propranolol-treated group after burns is lower than control (RD = −0.01), but this result is not statistically significant.…”

“…Ten trials were performed in the United States, and the remaining two were in Iran 17 and Pakistanp. 21 Almost all RCTs included patients with burns greater than 20% of TBSA, only one trial 18 limited the TBSA ≤20%. Interventions and comparisons were very similar, with propranolol (titrated to decrease HR by 20% of admission HR) and placebo or standard care being the intervention and comparison.…”

“…4,8 However, Nunez 9 et al synthesised the relevant researches and indicated that the mortality and sepsis of burn patients treated with propranolol were not significantly different from the control group, and there was also insufficient evidence to prove that the use of propranolol could reduce the length of hospital stay among burned patients. More and more randomised controlled trials (RCTs) [10][11][12][13][14][15][16][17][18][19][20][21] have been published in recent years. We performed a meta-analysis with the updated data, hoping to provide more evidence to evaluate the effectiveness and safety of using beta blocker in burned patients.…”