Posttraumatic Stress Disorder and Pain Impact Functioning and Disability After Major Burn Injury

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Journal of burn care & research: official publication of the American Burn Association (Impact Factor: 1.43). 01/2010; 31(1):13-25. DOI: 10.1097/BCR.0b013e3181cb8cc8
Source: PubMed


This study sought to clarify the prospective and concurrent associations of posttraumatic stress disorder (PTSD) and pain with functioning and disability after burn injury. The sample was composed of consecutive patients admitted to a regional burn center with major burn injuries (N = 171) who were followed at 1, 6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain Questionnaire and Davidson Trauma Scale, and the outcome measures were Short Form-36 Health Survey subscales administered at 6, 12, and 24 months after discharge. Linear mixed-effects analyses were conducted to evaluate pain and PTSD as predictors of functional outcomes. Higher PTSD symptom severity soon after hospital discharge was prospectively related to poorer physical and social functioning and greater psychosocial disability (P < .001). However, significant PTSD-by-time interactions also predicted future physical functioning and disability, indicating that the deleterious effects of early PTSD were ameliorated by time. In addition, at each follow-up, PTSD symptoms were concurrently related to greater physical and psychosocial disability, poorer social functioning, and less vitality (P < .001). More severe pain at each follow-up, but not PTSD, was correlated with poorer concurrent physical functioning (P < .002). Significant interaction terms indicated that the concurrent effect of PTSD on psychosocial disability, social functioning, and vitality attenuated during the 24-month recovery period. These findings suggest that assessing PTSD and pain following burn injury may aid in predicting future functioning. Future work should confirm this and evaluate whether aggressively treating both PTSD and pain helps improve functioning after major burn injury.

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    ABSTRACT: Starting from the evidence that not all burn patients develop a post-traumatic stress disorder (PTSD), the aim of this overview was to describe variables, which favour the development of the disorder following to burn injury and to delineate directions for a treatment. We searched articles in English related to PTSD in the population suffering from burns in the PubMed database, using the key word 'burn' in combination with: PTSD, traumatic event, trauma, ASD, and psychological factors. We concentrated our attention on articles published in the last decade (January 1998-March 2010). We found 32 articles. The risk factors concurring in the onset of PTSD are the presence of post-traumatic symptoms in the first following weeks to the burn, the avoidant coping, neuroticism, the presence of psychiatric disorder before the trauma, and the degree of disfigurement. The principal protective factors emerged from the review are the search of social or emotional support and extraversion. Information related to the treatment of these patients is scarce. The literature underlines the importance of the individual vulnerability to the development of PTSD in burn patients, besides the experience itself of a traumatic event. These patients face particular and specific problems, therefore, with the purpose to develop a suitable intervention, it would be useful to appraise, besides the physical and psychosocial implications of the burn, the psychological characteristics of each patient, to articulate a treatment that may account for the complexity of the burn patient.
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