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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000086
Original Articles

Results of a Pilot Multicenter 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 R. BS*; Platts-Mills, Timothy F. MD, MSc*; Holmes, James H. MD§; Hwang, James MD*; Cairns, Bruce A. MD*; McLean, Samuel A. MD, MPH*

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

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.

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.

© 2015 by Lippincott Williams & Wilkins

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