Pain, depression, and physical functioning following burn injury.

Abstract

Objective-Little is known about how pain and depression after burn injury may influence longterm outcomes such as physical functioning. This prospective study examined associations between pain, depression, and physical functioning in a sample of burn injury survivors.Design and Participants-Questionnaires assessing pain, depression, and physical functioning were completed by 64 (52% of original sample) adult burn survivors shortly after discharge from burn care and at 1-and 2-year follow-ups.Results-Pain and physical functioning improved over the 2 years of the study, whereas depression levels were stable. Pain and depression were associated with poorer physical functioning over time, but associations varied according to the time span under consideration. Also, the association between pain and physical functioning was strongest among persons with higher depression scores.Conclusions-Pain and depression may contribute independently to compromises in physical functioning. The co-occurrence of pain and depression represents even greater risk for reduced physical functioning over time among burn survivors. Keywordspain; depression; burn injury; functioning; quality of life Advances in emergency services and acute burn care in recent decades have led to extraordinary improvements in survival rates following burn injury. Nearly 95% of the approximately 40,000 persons who are hospitalized for burn injuries annually in United States will survive (American Burn Association, 2007) Much greater variability is found when outcomes beyond surviv ability are considered. For example, depression is well recognized as a significant problem following burn injury Patterson et al., 1993). For most burn survivors, average scores on depression indices fall within the mild to moderate range (Choniere, Melzack, Rondeau, Girard, & Paquin, 1989;Thombs, Haines, Bresnick, Magyar-Russell, Fauerbach, & Spence, 2007;Wiechman et al., 2001). However, moderate to severe symptoms of depression have been found in 18% to 45% of burn survivors years after their physical injuries have healed (Pallua, Künsebeck, & Noah, 2003;Wiechman et al., 2001).Pain is another serious problem for burn survivors, particularly during the early phases of burn care when open wounds are being subjected to debridement and movement therapies (Summer, Puntillo, Miaskowski, Green, & Levine, 2007). In addition, pain remain a concern for years after burn injury wounds have closed Choniere and colleagues (1989) found ongoing pain concerns 35% of a sample of burn survivors who were at least 1 year after injury. Similarly, Dauber, Osgood, Breslau, Vernon, and Carr (2002) an average of 10 years after injury reported the presence of pain. Of those with pain, 45% reported that pain interfered with their daily lives (Dauber et al., 2002). Malenfant and colleagues (1996) found pain in over 36% of their sample and demonstrated that pain prevalence, did not vary greatly between 1 and 4 years after injury. Although noting that the average severity of pain was mild (3.4 on a ...

Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn

“…Although an overall decrease in pain/discomfort over time was noted in both groups (Fig. 1), also reported in previous studies [19,[36][37][38], the pattern over time differed between the two groups. More specifically, patients in the no current pain group subsequently reported less pain/discomfort at each assessment point.…”

Quality of Life of Young Adult Survivors of Pediatric Burns Using World Health Organization Disability Assessment Scale II and Burn Specific Health Scale-Brief

“…Previous research has determined that while pain and physical function gradually returned to normal, depression did not change in the first two years post injury in adults. 3 Similarly, 30% of adult burn survivors show moderate to severe difficulties psychologically as well as socially. 22,23,24,25 This study has allowed us to follow individuals for much more time and determine their health, disability, and specific psychosocial and physical difficulties long term.…”

“…Also, pain and depression offer their own contributions to physical functioning and therefore play a huge role in the rehabilitation of burn survivors. 3 Pediatric burn survivors often have difficulties in the years post-burn, as seen through a high occurrence of PTSD paired with a low health-related quality of life (HRQOL). 4 Some sources state that while burn survivors depict normal QOL and psychological adjustment, they show fewer positive emotions.…”

Review of Burn Injury Research for the Year 2009

“…In addition, patients with severe pain and depression had more loss of physical function. 44 This article suggests that patients with severe pain and depression are at greatest risk for physical deterioration after burn injury. Earlier intervention may minimize deterioration of physical function.…”