Results of a pilot multicenter genotype-based randomized placebo-controlled trial of propranolol to reduce pain after major thermal burn injury.

MedStar author(s):
Citation: Clinical Journal of Pain. 31(1):21-9, 2015 Jan.PMID: 25084070Institution: MedStar Washington Hospital CenterDepartment: Surgery/Burn ServicesForm of publication: Journal ArticleSubject headings: *Adrenergic beta-Antagonists/tu [Therapeutic Use] | *Burns/co [Complications] | *Catechol O-Methyltransferase/ge [Genetics] | *Pain | *Polymorphism, Single Nucleotide/ge [Genetics] | *Propranolol/tu [Therapeutic Use] | Adult | Burn Units | Burns/dt [Drug Therapy] | Double-Blind Method | Female | Follow-Up Studies | Genotype | Humans | Male | Pain Measurement | Pain/dt [Drug Therapy] | Pain/et [Etiology] | Pain/ge [Genetics] | Patient Compliance/px [Psychology] | Pilot Projects | Time Factors | Treatment Outcome | Young AdultYear: 2015Local holdings: Available online from MWHC library: 1996 - presentISSN:
  • 0749-8047
Abstract: BACKGROUND: Results of previous studies suggest that beta-adrenoreceptor activation may augment pain, and that beta-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high-activity haplotype.CONCLUSIONS: Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.MATERIALS AND METHODS: Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high-activity COMT homozygotes were randomized to propranolol 240 mg/d or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5 to 19. Secondary outcomes assessed pain and posttraumatic stress disorder symptoms 6 weeks postinjury.RESULTS: Seventy-seven percent (61/79) of eligible patients were consented and genotyped, and 77% (47/61) were genotype eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention-to-treat and per-protocol analyses, patients randomized to propranolol had worse pain scores on study days 5 to 19.All authors: Bangdiwala SI, Bortsov AV, Cairns BA, Haith LR, Halawa OI, Holmes JH, Hoskins JM, Hwang J, Jones SW, Jordan MH, McLean SA, Orrey DC, Platts-Mills TF, Roane BR, Shupp JWFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-01-13
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25084070 Available 25084070

Available online from MWHC library: 1996 - present

BACKGROUND: Results of previous studies suggest that beta-adrenoreceptor activation may augment pain, and that beta-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high-activity haplotype.

CONCLUSIONS: Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.

MATERIALS AND METHODS: Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high-activity COMT homozygotes were randomized to propranolol 240 mg/d or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5 to 19. Secondary outcomes assessed pain and posttraumatic stress disorder symptoms 6 weeks postinjury.

RESULTS: Seventy-seven percent (61/79) of eligible patients were consented and genotyped, and 77% (47/61) were genotype eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention-to-treat and per-protocol analyses, patients randomized to propranolol had worse pain scores on study days 5 to 19.

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