Problems of pain and paresthesia in the healed wounds of burn patients are an understudied and poorly documented phenomenon. This descriptive study was designed to examine the prevalence and characteristics of these chronic sensory problems 1 year or more postburn. Four hundred and thirty patients were sent questionnaires which assessed the frequency and intensity of the problems, influencing factors and impact on patients' lives. These problems were assessed by rating scales (visual analogue and categorical scales) and the McGill Pain Questionnaire (MPQ). The response rate was 67%. Over one-third of the participants (36.4%) complained of pain while the prevalence of paresthetic sensations was 71.2%. More than half of the symptomatic patients experienced sensory problems every week sufficient to interfere with daily living. No relationships were found between these sensory problems and the patients' age or sex, burn etiology, or length of time elapsed since injury. Burn severity was related to the frequency of the problems. Discussion emphasizes the need for adequate treatment of these problems and suggests further research issues.
This study examined the characteristics of pain experienced by burned patients. Sources of inter-individual variations were also studied and the interrelationships between anxiety, depression, and pain were investigated. Forty-two adult patients hospitalized for burn injuries participated in the study. The McGill Pain Questionnaire and a visual analogue scale were employed to measure the pain experienced at rest and during therapeutic procedures. Anxiety and depression levels were assessed with the Spielberger State Anxiety Inventory, the Beck Depression Inventory, and visual analogue scales. The results showed that the pain varies greatly from patient to patient and undergoes wide fluctuations over time in each patient. The greatest pain is usually experienced during therapeutic procedures, the patients reporting significantly more pain on these occasions than at rest. Variations in pain severity were not related to socio-demographic characteristics of the patients, the length of time elapsed since the injury, or the quantity of analgesics administered. The extent of the burns was a significant predictor of pain but only in the first week after the injury. High levels of anxiety or depression were not necessarily associated with higher pain scores during therapeutic procedures but the patients who were more anxious or depressed tended to report more pain when at rest. These results are discussed in relation to pain management strategies, with particular emphasis on the need for the analgesic therapy to be highly individualized and frequently adjusted.
As the two principal research investigators, we are pleased that our large, long-term, multicentre study on persistent postcardiac surgery pain was published in CMAJ .[1][1] However, we strongly take issue with the Editor's comment in the April 15 print synopsis version regarding the data in the
Background Many studies have shown the efficacy of patient-controlled analgesia (PCA). However, it is not clear whether PCA has clinical or economic benefits in addition to efficient analgesia. The current study was designed to evaluate these issues by comparing PCA with regularly administered intramuscular injections of opioids after hysterectomy. Methods This prospective study included 126 patients who underwent abdominal hysterectomy and were randomly assigned to receive PCA or regularly timed intramuscular injections of morphine during a period of 48 h. Doses were adjusted to provide satisfactory analgesia in both treatment groups. Pain at rest and with movement, functional recovery, drug side effects, and patient satisfaction were measured using rating scales and questionnaires. The costs of PCA and intramuscular therapy were calculated based on personnel time and drug and material requirements. Results Comparable analgesia was observed with the two treatment methods, with no significant differences in the incidence of side effects or patient satisfaction. The medication dosage had to be adjusted significantly more frequently in the intramuscular group than in the PCA patients. The PCA did not favor a faster recuperation time compared with intramuscular therapy in terms of times to ambulation, resumption of liquid and solid diet, passage of bowel gas, or hospital discharge. The results of the economic evaluation, which used a cost-minimization model and sensitivity analyses, showed that PCA was more costly than regular intramuscular injections despite the fact that no costs for the pump were included in the analyses. Cost differences in nursing time favoring PCA were offset by drug and material costs associated with this type of treatment. Conclusions Compared with regularly scheduled intramuscular dosing, PCA is more costly and does not have clinical advantages for pain management after hysterectomy. Because of the comparable outcomes, the general use of PCA in similar patients should be questioned.
Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations.
