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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000086
Original Article: PDF Only

Results of a Pilot Multi-center Genotype-based Randomized Placebo-controlled Trial of Propranolol to Reduce Pain After Major Thermal Burn Injury.

Orrey, Danielle C. BA; Halawa, Omar I. MD; Bortsov, Andrey V. MD, PhD; Shupp, Jeffrey W. MD; Jones, Samuel W. MD; Haith, Linwood R. MD; Hoskins, Janelle M. PhD; Jordan, Marion H. MD; Bangdiwala, Shrikant I. PhD; Roane, Brandon BS; Platts-Mills, Timothy F. MD, MSc; Holmes, James H. MD; Hwang, James MD; Cairns, Bruce A. MD; McLean, Samuel A. MD, MPH

Published Ahead-of-Print
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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

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