The effects of relaxation breathing on procedural pain and anxiety during burn care

Introduction

Burn patients experience high levels of pain and anxiety during dressing changes. Relaxation breathing is a simple behavioral intervention to manage pain and anxiety. However, the information about the effects of relaxation breathing on pain and anxiety levels for burn patients during dressing changes is limited.

Methods

This study followed a quasi-experimental, pretest-posttest comparison group design without random assignment to groups. A total of 64 burn patients from Daejeon, South Korea were recruited by a convenience sequential sampling approach. With institutional approval and written consent, the experimental group practiced relaxation breathing during dressing change procedures. Data were collected from June to September 2011 using a VAS for pain and a VAS-A for anxiety.

Results

The homogeneity test was used to detect any significant group differences in the demographic data and pretest measures. The pain scores significantly differed between the 2 groups after intervention (RB group vs. control group, P = .01) and over time (pretest vs. posttest, P = .001). The anxiety scores significantly differed between the 2 groups (P = .01) and over time (P = .02).

Conclusion

Relaxation breathing is a simple and inexpensive technique nurses can use to help burn patients manage pain and anxiety during dressing changes.     

The effect of progressive muscle relaxation on anxiety and sleep quality in burn patients: A randomized clinical trial

Background and objectivesBurn patients experience a high level of anxiety and poor sleep quality due to their special physical and psychological conditions. The present study aimed to investigate the effect of progressive muscle relaxation on anxiety and sleep quality in burn patients.Methodology and participantsIn this randomized controlled clinical trial, a total of 80 patients admitted to burn ward were enrolled using convenient sampling and randomly assigned to one of the experimental or control groups. In the experimental group, patients were intervened using Jacobson’s relaxation technique 20−30 min daily for three consecutive days. During this period, the control group received only routine care and treatment. Patients' anxiety and their sleep quality were measured and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and St Mary’s Hospital Sleep Quality Questionnaire (SMHSQ) respectively. Eventually, data analysis was conducted using SPSS version 20.0 software (IBM Corp., Armonk, N.Y., USA).ResultsThe findings of the present study showed a statistically significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group (P < 0.05).ConclusionRelaxation as a complementary method can be used along with modern medicine to reduce anxiety and improve sleep quality in burn patients.     

The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomized controlled trial

Pain and anxiety caused by burn dressing change are one of the major issues in burn patients. In this regard, guided imagery as a complementary method can be effective in reducing the levels of anxiety and pain. This method is the process of creating mental images and using sensory features through the individual's imagination and memory that facilitate the achievement of desired therapeutic outcomes. Therefore, this study was aimed at determining the effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing change in burn patients. This is a single-blinded randomized controlled trial in which a total of 70 burn patients were enrolled using convenience sampling and randomly allocated to two groups of intervention and control (n = 35 in each group). Each patient in the intervention group received four sessions of guided imagery during four consecutive days (one session a day) using a headphone. Then in both groups, the level of pain was assessed after the dressing change and the level of pain-related anxiety was assessed before the dressing change (between the end of the intervention and the initiation of dressing change). Data were collected using a demographic questionnaire, the Visual Analog Scale (VAS), the short-form McGill Pain Questionnaire (SF-MPQ), and the Burn Specific Pain Anxiety Scale (BSPAS). Data were first entered into the IBM SPSS Statistics for Windows, version 25.0 and then analyzed using repeated-measures Analysis of Variance. The repeated measures ANOVA indicated the mean score of the quality and severity of pain and pain-related anxiety differed statistically and significantly after the intervention (during the four sessions) compared to before it (baseline) in the intervention group (p < 0.001). The independent-samples t-test indicated a statistically significant difference in the mean scores of the quality and severity of pain and pain-related anxiety between the two groups (p < 0.001). This difference was found to be significant from the second session onwards (p < 0.001). Medical staff, including physicians, nurses and other healthcare professionals, are responsible for developing strategies to manage complications of burn injuries. Considering the effectiveness of guided imagery in reducing anxiety and pain in burn patients, it is recommended to use this method of complementary medicine to manage stress, anxiety, and pain in these patients.     

Comparison of the effects of Benson relaxation technique and nature sounds on pain,anxiety, and body image in burn-injured patients admitted to the burn ICU: A single-blind randomized clinical trial

BackgroundBurn patients feel a lot of physiological and mental stress during treatment and rehabilitation which often cause anxiety and body image dissatisfaction. This study aimed to compare the effects of the Benson relaxation technique and nature sounds on pain anxiety and body image in burn-injured patients admitted to a burn intensive care unit (BICU).MethodsThis single-blind randomized clinical trial studied 60 burn patients allocated into three groups (Benson relaxation, nature sounds, and control) from September 2021 to February 2022. The patients received the intervention for seven consecutive days in person. Burn Specific Pain Anxiety Scale (BSPAS), was completed on the 1st, 4th, and 7th days. The intervention continued for four weeks measuring body image using the Satisfaction with Appearance Scale (SWAP) at the end of the 1st, 3rd, and 5th weeks. Finally, the data were statistically analyzed using the Shapiro–Wilk test, chi-square test, Fisher’s exact test, Bonferroni post hoc test, repeated measures ANOVA, Kruskal Wallis test, and Generalize Estimating Equations (GEE).ResultsThe mean pain anxiety and dissatisfaction with the appearance were high in the three groups in the pretest. On the 7th day after the intervention, the ANOVA showed that the mean pain anxiety decreased significantly in Benson's relaxation and nature sounds groups in three stages (before intervention (S1), after intervention (S2) and immediately after dressing change (S3) (P < 0.001). Correspondingly, the Kruskal Wallis test revealed that the body image dissatisfaction decreased significantly in the three groups at the end of the 3rd and 5th weeks (P < 0.001). The mean scores of pain anxiety showed that the nature sounds group proved more effective than the Benson relaxation technique. Also, the means scores of body image satisfaction showed that the Benson relaxation technique proved more effective than nature sounds.ConclusionThe study findings suggested that the Benson relaxation technique and nature sounds effectively reduces pain, anxiety, and improves body image satisfaction in patients with burn injuries.     

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients

BackgroundOne of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients.MethodsThis study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5?10 min before dressing change and 5?10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi?square, Mann–Whitney, Fisher’s exact tests, and paired t-test. The Kolmogorov–Smirnov test was used to check the normality of data.ResultsThe results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days.ConclusionsOur results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.     

The effect of virtual reality on pain,anxiety, and fear during burn dressing in children: A randomized controlled study

Aim and objectivesVirtual Reality (VR) can be used during painful procedures in children. This research was conducted to determine the effect of VR on the pain, anxiety, and fear levels experienced by patients during burn dressing.MethodsA randomized between groups study design was used to test whether VR reduced pain, fear, and anxiety during burn wound cleaning. The experimental (VR group) (n = 33) and the control group (n = 32) were determined using the simple randomization method for the children participating in the study (n = 65). The data were collected using the Wong–Baker FACES Pain Rating Scale, Children’s Fear Scale, and State- Trait Anxiety Inventory for Children. In addition, oxygen saturation and heart rate measurements were recorded before and after the procedure.ResultsUsing a between groups t-test, burn injured children in the group that received virtual reality (M = 2.6, SD = 1.9, SE= 0.21) showed significantly less pain intensity during burn wound care than the No VR control group (M = 4.2, SD =1.0, SE= 0.19, t = −5.89, p < 0.005). Similarly, the VR group reported significantly lower fear during wound care (M= 2.24, SD = 1.1, SE=0.19) than the No VR control group (M=3.72, SD = 0.6, SE=0.10, t = 6.70, p < 0.005), and on a scale from 0 to 100, patients in the VR group showed significantly less anxiety (36.46, SD = 8.1, SE=1.40) than patients in the No VR group (M= 53.16, SD = 7.4, SE=1.35, t = 8.52, p < 0.005). Heart rate during wound care was significantly lower in the VR group (M=119.60, SD = 8.1, SE=1.40) than in the No VR control group (M=129.56, SD = 10.64, SE=1.88, t = −4.25, p < 0.005). However, no significant difference in Oxygen saturation was found, (VR = 97.03, SD = 0.90, SE= 0.17, vs. No VR = 96.94, SD = 0.29, SE=0.23, t = 0.326, p > 0.05).ConclusionsVR is an effective method in reducing pain, fear, and anxiety caused by burn dressing in children aged 7–12. The use of VR during burn dressing was determined to have positive results on some physical and psychological parameters.     

The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU)

BackgroundBurn-specific pain anxiety and sleep disorders are common factors in burned patients that affect wound healing process, as well as the severity of burn pain. This study aimed to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICU.MethodIn this randomized controlled clinical trial, 52 patients were assigned by permuted block randomization 1:1 to the intervention (n = 26) and control (n = 26) groups. The intervention group received 20 min of foot reflexology massage during 3 days on their third, fourth and fifth days of hospitalization and 15 min before changing wound dressings. Patients in the control group merely received routine care. The Burn-Specific Pain Anxiety Scale (BSPAS) was completed for three consecutive days before and after changing wound dressings, and St. Mary's Hospital Sleep Questionnaire (SMHSQ) was filled out for four consecutive days before changing wound dressings for patients in both groups. The data were analyzed by IBM SPSS 16 software, Chicago, independent t, Chi-square, Friedman, Mann–Whitney and Wilcoxon tests.FindingsWe found no significant difference between pain-anxiety in the two groups before the intervention. The trend of different days in each groups were compared with Friedman test and showed that pain anxiety (p < 0.001), sleep latency (p < 0.001), duration of the last day's sleep (p < 0.001) and satisfaction of the last night sleep (p < 0.001) had a significant difference. In addition, Mann–Whitney test results showed that there were significant differences between the two groups at different times in terms of the above variables (p < 0.05). The effect size was = 0.82 for pain anxiety between group after the intervention.ConclusionBased on the results, foot reflexology massage can effectively reduce pain anxiety levels and improve sleep quality and quantity of patients with burn injuries; therefore, this non- pharmacological therapeutic method is recommended to be used in the burn ICUs. (Clinical trial’s registration code: IRCT20110906007494N27)     

The effect of inhalation aromatherapy with damask rose essence on pain intensity and anxiety in burned patients: A single-blind randomized clinical trial

IntroductionPain and anxiety are a major problem of burn patients. Despite the use of different medications, patients still suffer from these two problems. Aromatherapy along with medication may help in alleviating these symptoms. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients.MethodsThis three group clinical trial was conducted on 120 patients with burns less than 30% TBSA. The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no intervention.ResultsBaseline state–trait anxiety and pain intensity were similar in these three groups (p > 0.05). We found a significant reduction in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups (p < 0.001). However, we found no significant difference between the placebo and control groups in terms of these variables at these times (p > 0.05). Also, we found no significant difference among three groups in frequency of analgesics drugs and trait anxiety after intervention (p > 0.05).ConclusionInhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.     

Hypnosis for reduction of background pain and pain anxiety in men with burns: A blinded,randomised, placebo-controlled study

Introduction

‘Background pain’ and ‘pain anxiety’ are among the numerous problems of patients with burns. Non-pharmacological and pharmacological interventions have been used to reduce background pain and pain anxiety. This study compared the effectiveness of hypnosis and ‘neutral hypnosis’ (as a placebo in the control group) in decreasing the background burn pain and pain anxiety of adult male survivors with burns.

Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country

Objective

The purpose of this study was to ascertain the feasibility and potential effect of a low-cost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacological analgesia, on reducing pain and anxiety in adult burn patients undergoing physiotherapy treatment, compared to pharmacologic analgesia alone at a South African hospital.

Study design

Single-blind, within-subject study design.

Methods

Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Box-and-whisker plot method, Chi-square tests as well as the Student's paired t-test were used to analyze data.

Main findings

Eleven eligible adult burn patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23–54 years). A marginal (p = 0.06) to insignificant (p = 0.13) difference between the two sessions (analgesia with VR and analgesia without VR) in reducing pain was found. No significant difference (p = 0.58) was found between the two sessions (analgesia with VR and analgesia without VR) for anxiety.

Conclusion

There seems to be a trend that the low-cost VR system, when added to routine pharmacological analgesics, is a safe technique and could be of considerable benefit if implemented into the pain management regime of burn units at a South African hospital.     

哌拉西林/他唑巴坦防治烧伤感染的多中心临床试验

目的　评价哌拉西林 /他唑巴坦防治烧伤感染的疗效。　方法　选择脓毒症或烧伤总面积大于 5 0 %TBSA或Ⅲ度烧伤面积大于 30 %TBSA的脓毒症高危患者 6 3例。给药方案为 ,治疗脓毒症剂量 4 .5g ,1次 /6～ 8h ;预防性治疗剂量 4 .5g ,1次 /8h。静脉给药。脓毒症状完全消失或局部创面感染未发展成脓毒症为有效。　结果　总有效率为 90 .4 % ,控制脓毒症有效率为 75 % ,预防局部创面感染发展成脓毒症有效率为 95 .7%。治疗组和预防性治疗组细菌清除率分别为 71.4 %和5 1 4 %。　结论　在烧伤中心 ,哌拉西林 /他唑巴坦是治疗病原菌敏感的脓毒症和预防性治疗经验性用药的有效抗生素。     

The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient

This retrospective review of 286 acute pediatric burn survivors treated in 2001 evaluated the effectiveness of a pharmacotherapeutic protocol for pain, anxiety, and itching. Background pain, procedural pain, exercise pain, anxiety, incidence of acute stress disorder (ASD), and itch were measured with standardized instruments. When this review was compared to similar reviews done in 1993-1994 and 1998, a steady trend toward using more potent pain medications in this patient population is evident. While the use of acetaminophen alone decreased from 50.6% of patients in 1993-1994 and 26.3% in 1998 to 7.3% in 2001, the use of opiates increased from 44.8% in 1993-1994 and 66.9% in 1998 to 81.3% of patients in 2001. Likewise, the use of benzodiazepines for anxiety has increased from 59.8% in 1998 to 77.5% of patients in 2001. During that same period the incidence of ASD decreased from 12.1% in 1993-1994 to 8.7% of patients in 2001. For effective pain and anxiety management, the average administered dose of lorazepam and morphine also increased, providing impetus to revise the pharmacotherapeutic pain protocol. Having a standard pain protocol furnishes a framework for periodic review and facilitates updating of pain and anxiety treatment practices.     

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: A randomized controlled trial

ObjectiveTo evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn.MethodOne hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter^®, Tewameter^®, Sebumeter^®, and Cutometer^®, respectively.ResultsThe scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension.ConclusionOur results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.     

The association of patient and burn characteristics with itching and pain severity

Introduction

Itch after burn injury causes significant distress to patients and can hamper functional recovery. Itching can persist on a time scale ranging from several weeks to even years after injury. In this study, we sought to determine predictors of itching after burn injury.

Acute pain management in burn patients: Appraisal and thematic analysis of four clinical guidelines

ObjectiveBurn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.MethodThe study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.ResultsThe overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.ConclusionThe study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.     

烧伤创面脓毒症诊断的细菌学意义及临床分期

目的　探讨并重新评价烧伤创面脓毒症与组织细菌定量的关系 ,将其进行临床分期。　方法　对近 5年符合条件的 32例烧伤患者进行组织细菌检查和定量分析 ,结合临床表现对创面脓毒症进行分期。　结果　 (1) 32例患者的 12 3个组织标本中 ,均可见到细菌侵入 ,有 82个标本的每克痂下组织菌量≥ 1× 10 5,4 1个标本的每克痂下组织菌量 <1× 10 5。其中 18例患者 6 8个标本 ,每克痂下组织菌量全部≥ 1× 10 5;5例患者 2 0个标本 ,每克痂下组织菌量全部 <1× 10 5;其余 9例患者的标本中仅部分每克痂下组织菌量≥ 1× 10 5。 (2 )根据细菌学结果并结合临床表现 ,可将创面脓毒症分为Ⅰ～Ⅳ期。　结论　 (1)临床有中毒表现并获得细菌侵入活组织的证据时 ,创面脓毒症的诊断即可成立。 (2 )将创面脓毒症分为IV期 ,有助于规范临床诊断、指导临床治疗     

The effect of Extracorporeal Shock Wave Therapy in the treatment of burn scars: A prospective,randomized, controlled trial

BackgroundCurrent scientific evidence on the effect of Extracorporeal Shock Wave Therapy (ESWT) as adjunctive treatment for burn scars is scarce. However preliminary evidence, indicates it might prove a useful tool.Materials and methodsA prospective, randomized, controlled study was conducted from February 2017 to February 2019. Patients with burn scars were divided into two groups with twenty patients per group. The control group received the standard treatment for burn scars. The ESWT group received the standard treatment and treatment of burn scars with ESWT 512 impulses of 0.15 mJ/mm² in each session, twice per week for 4 weeks. We assessed the appearance of scar with the Vancouver Scar Scale (VSS), pruritus and pain with Visual Analog Scale (VAS) before the start of the treatment and at 2 weeks and 5 months after the treatment.ResultsBoth groups showed improvements in all variables through the study. However, these improvements were only statistically significant for the VSS at the 6th month for the control group and VSS and VAS pain and pruritus for the ESWT group. Nonetheless the results failed to show statistically significant differences between the ESWT and the control group neither at two weeks after treatment nor at 5 months after treatment.ConclusionOur study questions the relevance of ESWT as adjunctive treatment for burn scars as far as outward appearance, pain and pruritus as end-results are concern. Nonetheless, further studies are required to accurately assess the potential benefits of ESWT as an adjunctive treatment for burn scars.