Pain Scores with Atypical Pain Regimens in Severe Burn

INTRODUCTION: Severely burned patients receive a variety of medications to alleviate their pain. We wondered if there are differences in reported pain scores and acceptable levels of pain in patients who receive only opioid analgesics versus patients who receive atypical pain medications in addition to opioids. METHODS: The regional burn center's database was queried for subjects with greater than 20% TBSA (total body surface area) burn admitted from January 2011 to March 2014. Subjects who received only opioid medications were categorized into the "opioid" group, and those who received any combination of atypical non-opioid pain medications in addition to opioids were in the "non-opioid" group. Non-opioid medications included typical and atypical antipsychotics, benzodiazepines, SSRIs, and heterocyclic antidepressants. The non-opioid subjects were matched for TBSA burn, age, and gender with opioid subjects. Pain scores and reported acceptable levels of pain were collected from review of the electronic medical record. Scores were averaged from the first five days of hospitalization and compared to scores from the last five days of hospitalization to evaluate for differences. Statistical analysis was performed with SigmaPlot using t-test, Mann-Whitney, chi-square, and Wilcoxon signed rank test where appropriate. RESULTS: Twenty-eight subjects were identified in each cohort. The median TBSA burn was 25% (21, 31[IQR]) in non-opioid subjects and 28% (24, 32 [IQR]) in opioid subjects. The median length of stay was 31 days and the mean age was 42 years for both groups. There was no statistical difference in TBSA burn, gender, age, or length of stay between groups. We found no differences in pain scores or acceptable pain levels between groups at either time points. Paired t-test demonstrated no statistical change in pain scores over hospitalization in the opioid group. However, those who received non-opioid pain medications had a statistical improvement (p = 0.018) in pain scores over their hospitalization from 2.5 (1.6, 3.9 [IQR]) to 1.8 (1.2, 2.5 [IQR]) at the end. There was no statistical difference in the acceptable level of pain over hospitalization in either group. CONCLUSIONS: Our results suggest improved pain scores with atypical pain regimens compared to opioid-only treatments.