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.
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 5-19. Secondary outcomes assessed pain and posttraumatic stress disorder (PTSD) symptoms 6 weeks post-injury.
Results: Seventy-seven (61/79) percent 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 5-19.
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.
(C) 2014 by Lippincott Williams & Wilkins