Treatment-resistant pain and distress during pediatric burn-dressing changes.

Recent research has suggested some efficacy for the use of hypnosis in the control of pain and distress in a pediatric population undergoing painful medical procedures. Here, we study a sample (N=23) of pediatric subjects undergoing burn-dressing changes and receiving either an imagery-based or control (social-support) treatment. Subjects' levels of distress were assessed with the Observational Scale of Behavioral Distress. Results indicated that distress behaviors in this population can be measured reliably using this scale. However, no support was found for the main hypothesis that imagery treatment would be superior to control treatment in the alleviation of distress, nor were these treatments effective in comparison to baseline conditions. We discuss the formidable problem that burn and dressing-change pain presents, as well as the reasons why this treatment attempt might have failed to have the predicted effects. We also discuss important developmental considerations regarding the adequate assessment of pain and distress.

A quasi-experimental, dual-center study of morphine efficacy in patients with burns.

The efficacy of morphine sulfate for the relief of pain and anxiety in patients with burns was investigated in a quasiexperimental, dual-center study. More than 100 patients at two burn centers in Iowa were studied. One of the units used no morphine or morphine derivatives for the control of pain (the no-morphine unit), and the other used moderate to high doses of morphine for the relief of pain (the morphine unit). Patients were asked to rate their pain and anxiety after hydrotherapy and at rest in the afternoon on a daily basis throughout their stays. Side effects were also measured, and nurses made ratings of the patients' pain and anxiety during morning hydrotherapy. Results indicated that pain and anxiety decreased significantly from hydrotherapy to afternoon assessments and decreased significantly during the patient's hospital stay. Unexpectedly, however, patients at the no-morphine unit consistently reported lower levels of pain and anxiety than did patients at the morphine unit. These results could not be explained by differences in burn size or number of surgeries across units. Other possible explanations are offered.