Opioid dependence and treatment outcomes among patients with burn injury

BackgroundPatients with burn injuries cause significant healthcare economic burden, often utilising extra-hospital resources, caregiving, and specialized care.MethodsWe present a retrospective cohort analysis of the hospitalized patients in the USA with a primary diagnosis of burn injury. Opioid dependence was identified using ICD-10 CM codes. The 30-day all-cause readmission rate was the main outcome while secondary outcomes were inhospital mortality rate, resource utilization which included hospital length of stay, total hospitalization costs and charges and surgical procedures for burn injury treatment as well as the most important five principal diagnoses for admission and readmission.ResultsOut of 22,348 patients included in the study, 597 had opioid dependence. Older patients (43 years, range: 38.6–47.2 years) as well as males (70.8%) were more likely to be opioid dependent. Opioid dependence was associated with higher 30-day readmission rates (aOR: 1.83, 95% confidence interval (CI): 1.30–2.57, p-value: <0.01), higher total hospitalization costs (aMD: $14,981, CI: $3820–$26,142, p-value: 0.01), total hospitalization charges (aMD: $47,078, CI: ?$5093 to $89,063, p-value: 0.03), and a shorter mean length of stay (aMD: 5.13 days, CI: 2.60–7.66, p-value: <0.01). However, patients with and without opioid dependence had similar in-hospital mortality rates (aOR: 0.27, CI: 0.06–1.28, p-value: 0.10).ConclusionWe are the first to our knowledge to report the association of treatment outcomes and opioid dependence in patients hospitalized at the national level with a burn injury. We show that there were higher 30-day all-cause readmission rates and in-hospital resource utilization among patients with opioid-dependence.     

Outpatient opioid use of burn patients: A retrospective review

IntroductionOpioid overuse is a growing patient safety issue but continue to be integral to burn pain management. This study aims to characterize opioid use in discharged patients and factors for predictive of long term use.MethodsParticipants with burns admitted to a single center from 2006 to 2015 were included. Total outpatient morphine equivalent dose (MED) was recorded at discharge and each clinic visit. Burn size, percent grafted, age, sex, and preadmission drug use were collected. For each time point, multivariate logistic regression was performed to examine the relationship of discharge MED and long-term opioid use, adjusting for age, sex, burn size, and percent grafted. MED was divided into low (0–150 mg per day), medium (151–300 mg per day), and high (greater than 301 mg) groups on day of discharge.ResultsAt discharge, 366 (90%) patients received opioids. At day 14, both the medium MED (OR 2.72; CI 1.18–6.23) and high MED (OR 2.74; CI 1.02–7.37) groups had an increased risk for continued opioid use. On day 60, only the high MED group (OR 6.06; CI 1.60–22.97) had an increased risk. History of drug use was significant at 60 days (OR 7.67; 1.67–35.26) and alcohol use was significant at 14 days (OR 3.14; CI 1.25–7.93) and 30 days (OR 5.92; CI 1.81–19.36).ConclusionsWhereas opioids are widely prescribed upon discharge, most patients no longer use them 30 days later. Higher opiate utilization at discharge increases risk of long term use, as does pre-injury drug and alcohol use, but only temporarily.     

A population-based retrospective cohort study to assess the mental health of patients after a non-intentional burn compared with uninjured people

Background

The objective of this study was to describe and quantify mental health (MH) admissions experienced by patients with unintentional burns subsequent to their injury.

Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients

Objective Videoscopic splanchnicectomy (VSPL) is a method of pain relief in chronic pancreatitis patients. Because this method is not equally effective in all patients, this study was designed to identify the factors determining the unfavorable results of VSPL. Materials and methods This is a non-randomized prospective case-controlled study designed to compare a group of patients suffering from chronic pancreatitis treated with VSPL (N = 48) versus a group of patients treated symptomatically (N = 42). The outcome was measured as the intensity of pain ailments [visual analog scale (VAS)-pain scale] and subjective satisfaction of the patients from the surgical treatment [Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS)]. The predictive variables considered in this study were: age, sex, emotional status, social support (the two last variables were measured by subscales of quality-of-life questionnaire from the group of FACIT), history of previous surgical treatment, and opioid use for at least 3 months before VSPL. The follow-up was 18 months. Logistic regression was performed using dichotomized pain as outcome variable: high score more than 66.7 on VAS scale and low under 50 points on VAS scale 18 months after VSPL. Results VSPL significantly reduced the pain ailments at all points of the study when compared to the control. However, the pain intensity at the end of the study was higher than directly after the surgery. In the patients treated with opioids before the surgery, the pain intensity was significantly higher than in the patients not using this group of drugs. Logistic regression revealed that opioid administration before VSPL was the most important predictor of high pain scores 18 months after the surgery. Conclusion When planning the VSPL in the treatment of pain in patients suffering from chronic pancreatitis, it is necessary to take into consideration the previous chronic use of opioids, as this variable can significantly influence poorer results of this surgical pain management.     

Alcohol use and smoking in burn patients at the Helsinki Burn Center

Objective

We investigated alcohol use and smoking at time of burn and their relationships with severity of burn and presence of mental disorders.

Co-morbid traumatic brain injury and substance use disorder: childhood predictors and adult correlates

Primary objective: To examine demographic factors, childhood experiences and behaviour problems and adult psychopathology associated with a history of adult traumatic brain injury (TBI) with unconsciousness in patients with substance use disorders (SUD).

Design and methods: Voluntary patients (n = 550) undergoing treatment for SUD were compared for clinical and demographic variables based on report of TBI.

Results: Among the 218 (40%) patients reporting TBI, 61% were men. Childhood conduct problems and loss of a parent were strongly associated with adult TBI. Patients with TBI had more severe SUD and higher rates of depressive and anxiety symptoms, somatic concerns, physical trauma, attempted suicide and Antisocial Personality Disorder.

Conclusions: Men have a higher rate of TBI than women, but women with SUD have an increased relative risk of TBI compared to women in the general population. Childhood conduct problems and loss of a parent in childhood may predict adult risk-taking behaviour that leads to TBI in patients with SUD. TBI is associated with higher rates of psychopathology in patients with SUD.     

Music therapy and music medicine interventions with adult burn patients: A systematic review and meta-analysis

BackgroundPain is one of the most common and most difficult symptoms to manage in adult burn patients in the Intensive Care Unit (ICU). Insufficient or unsuccessful pain management can negatively affect physiological, psychological, and social health in burn patients, both during and after hospitalization. Music therapy and music medicine interventions have been shown to positively affect pain and mental health in this population. This systematic review and meta-analysis provide an update of Randomized Controlled Trials (RCTs) using music therapy or music medicine interventions in adult burn patients.MethodsA variety of databases were searched from their beginning to June 2020, including PsycINFO and PsycArticles (via APAsycNET), PubMed and MEDLINE (via OvidSP), Scopus, Web of Science, and the Cochrane Library. Data of all articles meeting the inclusion criteria were extracted, organized, and processed according to the PRISMA guidelines. Statistical analysis was performed using Q-test and I2 statistics.Results10 RCTs with a total of 1061 participants were included. The results of the meta-analysis showed a statistically significant reduction of pain (I² = 96.03%, P < 0.001), anxiety (I² = 98.85%, P < 0.002), and improved relaxation (I² = 87.19%, P < 0.001) favoring music interventions compared to control groups.ConclusionsThis review provides preliminary evidence for the effectiveness of music interventions for adult burn patients. However, more high-quality RCTs are needed to safely establish guidelines for music therapists and other health care professionals in using music for health purposes with this population.     

Defining numerical cut points for mild,moderate, and severe pain in adult burn survivors: A northwest regional burn model system investigation

IntroductionPain is a common and often debilitating sequela of burn injury. Burn pain develops following damage to peripheral sensory nerves and the release of inflammatory mediators from injury. Burn pain is complex and can include background and procedural pain that result from the injury itself, wound care, stretching, and surgery. Clinicians and researchers need valid and reliable pain measures to guide screening, treatment, and research protocols. Unlike other conditions, visual analog, or numeric pain rating scale (VAS/NRS) scores that represent mild, moderate, and severe pain among people with burn injury have not been established. The aim of this study was to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in adult burn survivors using a PROMIS Pain Interference (PROMIS-PI) short form.MethodsAn average pain intensity VAS/NRS score (0?10) and customized PROMIS-PI short form were administered to adults with burn injury treated at a regional burn center at hospital discharge (baseline) and at 6, 12, and 24-months after injury. To identify pain intensity scores that represent mild, moderate, and severe pain, we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. Optimal cut points were considered those with the highest ANOVA F statistics. Models with similar F statistics were also compared with BIC.ResultsData from a sample of 253 participants (83% white, 66% male, mean age 47 years) with VAS/NRS pain intensity and PROMIS-PI scores at one or more timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at baseline and 12-months. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was only 2.2.ConclusionsVAS/NRS scores for pain among adults with burn injury can be categorized as mild (0?2), moderate (3?5), and severe (6?10). These findings advance our understanding regarding the meaning of pain intensity ratings after burn injury, and provide an objective definition for clinical management, quality improvement, and pain research.     

Comparative study of conventional and topical heparin treatment in second degree burn patients for burn analgesia and wound healing

Objective

To compare clinical outcome of topical conventional with topical heparin treatment in 2nd degree or partial thickness (PTB) burn patients.

Dimensions of burn survivor distress and its impact on hospital length of stay: A national institute on disability,independent living,and rehabilitation research burn model system study

ObjectiveGuided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.MethodsData collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.ResultsAlthough counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.ConclusionA need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.     

Identification of substance use disorders in burn patients using simple diagnostic screening tools (AUDIT/DAST-10)

Introduction and objectivesSubstance use is disproportionately high in burn patients and associated with adverse outcomes. Screening methods for substance use disorders may help predict or avoid adverse outcomes.The University of Utah Burn Center records self-reported Alcohol Use Disorders Identification Tests (AUDIT) and Drug Abuse Screening Tests (DAST-10) for all adult burn admissions. This study assessed for association between AUDIT/DAST-10 scores and burn patient outcomes.MethodsA retrospective chart review of adult burn patients admitted to the University of Utah from 05/01/2014–06/30/2017. Patient demographics, injury data, and substance use data were collected and analyzed.Results322 patients underwent AUDIT/DAST-10 screening (n = 322). 56 (17.4%) had positive AUDIT screens (score ≥ 8). 15/50 with alcohol use at time of injury (TOI) had negative AUDIT screens. Median AUDIT score with TOI alcohol use was 12, without TOI alcohol use was 1. 30/55 patients offered alcohol counseling accepted.14 patients (4.3%) had positive DAST-10 screens (score ≥3). 9/25 with drug use at TOI had negative DAST-10 screens. No patients without TOI drug use had DAST-10 scores >2. 9/11 patients offered drug counseling accepted.Mean standardized length of stay (LOS) per TBSA burn injury was 1.7 days for positive AUDIT, 1.6 days for negative AUDIT. Median standardized LOS was 1.4 days for positive DAST-10, 1.7 days for negative DAST-10.ConclusionsAUDIT and DAST-10 screens can identify burn patients with problematic substance use, allowing early intervention. Positive screening scores do not independently predict longer hospital stays, increased wound severity, or treatment noncompliance.     

心理一致感在老年患者睡眠障碍与心理健康的中介效应

目的探讨心理一致感在老年患者睡眠障碍与心理健康的中介效应,为改善老年患者睡眠障碍、促进其心理健康提供参考。方法抽取锦州、大连、沈阳市6所三级甲等医院的住院老年患者650例,采用心理一致感量表(SOC-13)、心理健康指数量表(WHO-10)和匹兹堡睡眠质量指数量表(PSQI)进行调查。结果老年患者睡眠障碍得分为7.25±3.74,心理一致感得分为67.17±7.30,心理健康得分为13.28±3.09,老年患者睡眠障碍与心理一致感、心理健康呈显著负相关(均P0.01),心理一致感与心理健康呈显著正相关(P0.01),心理一致感在住院老年患者睡眠障碍与心理健康间起部分中介作用。结论心理一致感是睡眠障碍和心理健康的中介变量,可降低睡眠障碍对心理健康的不良影响。提高住院老年患者的心理一致感有助于促进患者的心理健康,从而促进患者疾病的康复。     

Epidemiology and factors associated with acute stress disorder in burned patients: a case-control study

IntroductionA burn injury is a very painful experience, with subsequent emotional problems, which have been gaining relevance to the extent that survival from burns has improved. Among the alterations of the mental sphere in this population is Acute Stress Disorder (ASD) that has been described in up to one-third of patients with major burns.MethodologyA nested case-control study was carried out in a cohort of hospitalized patients in a burn referral unit, in patients over 16 years of age. A total of 135 patients, 41 cases, and 94 controls were included. All of them underwent a psychiatric interview, a standardized form was filled out on sociodemographic and clinical information, and the PID-5-BF scale was applied to evaluate associated personality elements. The diagnosis of acute stress was made with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.ResultsThe incidence of acute stress was 23.4%. When the clinical and sociodemographic characteristics of both the cases and the controls were compared, the risk factors were subsidized insurance, flame burn, burn in a special area, third-degree burn, high pain, stay in the Intensive Care Unit (ICU), peritraumatic amnesia and life threat. Patients also had a higher percentage of burned body surface, higher average pulse, longer hospital length of stay, higher average in the negative affect variable and in the psychoticism variable of the PID-5-BF scale. But for the multivariate analysis using logistic regression, the model that best explains the presence of acute stress only includes the variables life threat (Odds Ratio adjusted (ORa): 117.0; Confidence Interval (CI): 10.9–1258.5), severe pain (ORa: 9.9; CI: 1.8–52.8), electrical burn (ORa: 20.8; CI: 17.2–250), burn in a special area (ORa: 8.9; CI: 1, 0–76.8), third-degree burn (ORa: 10.4; CI: 0.7–166.7).ConclusionAcute stress disorder is frequent in the hospitalised burn population, and is more frequent than in other types of trauma. Associated factors with the presentation of Acute Stress Disorder are the feeling of life threat at the time of the burn, having pain classified as strong (Visual Analog Scale (VAS) 5–10), electrical burn, and burns in special areas.     

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.     

Nocturia in relation to somatic health, mental health and pain in adult men and women

OBJECTIVE: To assess the relationship of nocturia to somatic health, mental health and bodily pain. SUBJECTS AND METHODS: A randomly selected group of men and women aged 20-64 years, living in three small municipalities in northern Sweden, or in the city of Ostersund or in Stockholm, were sent a postal questionnaire containing questions on somatic and mental health, satisfaction with life, pain, nocturnal voiding, work and sick-listing from work. RESULTS: Reports (from 1948 respondents) on poor somatic and mental health and on pain all increased in parallel with increasing frequency of nocturnal voids. In a multiple logistic regression analysis with sex, age, somatic health, mental health and bodily pain as the independent variables, significant independent correlates (odds ratios, confidence intervals) of nocturnal micturition (two or more episodes vs none or one) were: age 45-59 vs 20-44 years, 1.9 (1.3-2.7), > or =60 vs 20-44 years, 3.8 (2.4-6.0); somatic health, poor vs good, 2.3 (1.4-3.7); mental health, poor vs good, 1.9 (1.2-3.0); pain, rather mild vs very mild or none, 1.5 (1.0-2.3); rather severe vs very mild or none, 1.9 (1.1-3.2); and very severe vs very mild or none, 6.0 (2.5-14.0). Gender was deleted by the logistic model. Sick-listing for > or = 60 days during the past year was reported by 4.9%, 10.6%, 5.6% and 38.9% of the men with none, one, two or > or = three nocturnal voids, respectively, and by 10%, 12.4%, 23% and 46.7% (both P < 0.001) of the corresponding women, respectively. Life satisfaction decreased in parallel with increased nocturia. CONCLUSION: The impairment of both somatic and mental health was associated with increased nocturnal voiding. Pain was associated with a substantial increase in nocturia after adjusting for age and somatic and mental health. Sick-leave was more common in association with more nocturnal voids.     

The role of concomitant alcohol and drug use in increased risk for burn mortality outcomes

BackgroundBurn injuries are a major cause of mortality and morbidity in low- and middle-income countries, with high rates in Sub-Saharan Africa. The risks may be heightened for persons who present with concomitant use of alcohol and illicit substances, which increase the risk for injury and severely compromise prognosis following injury.MethodsThis study utilised a national dataset on hospitalised burns in South Africa to explore the risk for mortality relative to morbidity. To assess the influence of alcohol and drugs in mortality outcomes, the analysis was restricted to adult cases, 18 years and older (N = 918). The primary statistical procedures used in the analysis were logistic regression models.FindingsThe results indicate that burn victims with full thickness and partial thickness burn degree and more than 30% TBSA had a significantly increased risk of mortality. In addition, the risk for mortality was increased ten times when concomitant alcohol and drugs were indicated compared to cases where these were absent. The length of stay in hospital diminished the risk for mortality by about 10%.InterpretationThe findings may be explained by the role of skin as the main barrier against infections and the concurrent increase in risk of infection based on the degree and extent of any damage. The combined presence of both alcohol and drugs may predispose towards more severe burns and greatly compromise liver function with heightened risk for sepsis and death.     

部队男性不育患者心理健康状况、婚姻质量及社会支持调查研究

目的探讨部队男性不育症患者的心理健康状况、婚姻质量及社会支持情况。方法采用症状自评量表-90、Olson婚姻质量问卷及社会支持评定量表对2017～2018年就诊于本中心的部队166名男性不育患者(A组)进行调查分析,并与同期就诊于本中心的地方300名男性不育患者(B组)及250名在本院体检的正常已育男性(C组)作对照分析。结果 A组及B组的症状自评量表-90结果中强迫症状、人际关系敏感、抑郁、焦虑4项因子得分均显著高于C组(P<0.05),且A组强迫症状、抑郁及焦虑3项因子得分显著高于B组(P<0.05);在婚姻质量问卷中A组与B组在婚姻满意度、夫妻交流、解决冲突方式及性生活4个因子的得分均显著低于C组(P<0.01),且A组这4个因子的得分更低于B组(P<0.05);在社会支持评定量表中,A组在客观支持、主观支持、支持利用度、社会支持总分4项的得分显著低于B组和C组(P<0.05),B组在主观支持、支持利用度、社会支持总分3项的得分显著低于C组(P<0.05)。结论部队不育男性的心理健康状况较差,婚姻质量及其社会支持度也偏低。这提示我们在以后的诊疗...     

Impacts of low-energy extracorporeal shockwave therapy on pain,pruritus, and health-related quality of life in patients with burn: A randomized placebo-controlled study

BackgroundThe management of post-burn pain and pruritus remain a potent challenge because of their bad effects on health-related quality of life (HRQOL). The main purpose of this study was to evaluate the impacts of low-energy extracorporeal shockwave therapy (low-energy ESWT) in the management of pain, pruritus, and HRQOL in patients with burn.MethodsForty-five adult patients with burn, their age ranged from 18 to 55 years, were included in the study, they randomly assigned into 22 patients in the study group (low-energy ESWT) and 23 patients in the placebo group. The study group received low-energy ESWT (0.05–0.20 mJ/mm², a frequency of 4 Hz with total shocks from 1000 to 2000 shocks) once per week for 4 successive weeks, while the placebo group received ESWT without energy. Both groups received traditional physical therapy program of selective different exercises (respiratory, range of motion, endurance, strengthening, balance, mobilization, stretching, and gait training) 3 days per week for 4 weeks. Numerical Rating Scale (NRS) for pain and for pruritus, Pressure Pain Threshold (PPT), 12-Item Pruritus Severity Scale (12-PSS), and Burn Specific Health Scale-Brief (BSHS-B) were measured before and after treatment procedures in both groups.ResultsNRS were decreased significantly in the study group than in the placebo group (P < 0.05). PPT, 12-PSS, and BSHS-B scores were improved more significantly in the study group than in the placebo group (P < 0.05) while body image and burn associated issues were improved at the same level in both groups (P > 0.05).ConclusionThe findings suggest that low-energy ESWT with traditional regular physical therapy may relive post-burn pain and pruritus, and improve HRQOL, particularly in adult patients with burn.