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

Abstract

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.

• Authors: Danielle C Orrey, Omar I Halawa, Andrey V Bortsov, Jeffrey W Shupp, Samuel W Jones, Linwood R Haith, Janelle M Hoskins, Marion H Jordan, Shrikant I Bangdiwala, Brandon R Roane, Timothy F Platts-Mills, James H Holmes, James Hwang, Bruce A Cairns, Samuel A McLean
• Journal: The Clinical journal of pain (Clin J Pain) Vol. 31 Issue 1 Pg. 21-9 (Jan 2015) ISSN: 1536-5409 [Electronic] United States
• PMID: 25084070 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Propranolol
• COMT protein, human
• Catechol O-Methyltransferase

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Burn Units
• Burns (complications, drug therapy)
• Catechol O-Methyltransferase (genetics)
• Double-Blind Method
• Female
• Follow-Up Studies
• Genotype
• Humans
• Male
• Pain (drug therapy, etiology, genetics)
• Pain Measurement
• Patient Compliance (psychology)
• Pilot Projects
• Polymorphism, Single Nucleotide (genetics)
• Propranolol (therapeutic use)
• Time Factors
• Treatment Outcome
• Young Adult