Anxiety In Burn Patients Research Articles

Effects of two non-drug interventions on pain and anxiety in the nursing process of burn patients: a literature review with meta-analysis.

Burns are a global health issue causing significant mortality and high medical costs. Non-pharmacological interventions such as music therapy and virtual reality (VR) therapy have shown potential in alleviating pain and anxiety in burn patients. This study systematically evaluates the impact of these interventions using a network meta-analysis. A systematic review and network meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42024566536). Searches in PubMed, Cochrane Library, Web of Science, and Embase up to November 22, 2023, identified randomized controlled trials (RCTs) involving music therapy or VR therapy in burn patients. The Cochrane Risk of Bias Tool (2.0) assessed study quality. Data were analyzed using StataMP-64 software. Seventeen RCTs with 1,119 burn patients were included. Both music therapy and VR therapy significantly reduced pain and anxiety compared to control groups. Music therapy was more effective for pain reduction (SUCRA: 85.4%), while VR therapy was superior for anxiety relief (SUCRA: 79.5%). Music therapy and VR therapy effectively reduce pain and anxiety in burn patients. Integrating these interventions into burn care can enhance patient outcomes. Further research is needed to confirm these findings and optimize individualized treatment plans. https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42024566536).

Effect of quality nursing care on wound pain and anxiety in burn patients: A meta-analysis.

To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: -1.79, 95% CI: -2.22 to -1.36, p < 0.001), anxiety (SMD: -2.71. 95% CI: -3.49 to -1.92, p < 0.001) and depression (SMD: -1.74, 95% CI: -2.35 to -1.14, p < 0.001) levels were significantly reduced post-trauma.

Prevalence of anxiety and its risk factors in burn patients: A systematic review and meta-analysis.

The primary objective of this systematic review and meta-analysis was to ascertain the prevalence of anxiety and identify associated risk factors among individuals who have suffered burn injuries. We conducted a thorough and systematic search across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the scientific information database (SID). Our search encompassed the period from the earliest available records up to 8 August 2023. We employed keywords derived from Medical Subject Headings (MeSH) such as "Prevalence", "Anxiety" and "Burns". In total, 2586 burn patients participated in 13 cross-sectional studies. The mean age of the participants was 32.88 (SD = 2.51). In a compilation of 13 studies, the documented overall occurrence rate of anxiety among burn patients stood at 16.1% (95% CI: 10.0% to 24.7%; I2 = 93.138%; p < 0.001). The outcomes of a meta-regression analysis, which examined the association between anxiety in burn patients and the year of publication, did not uncover any significant correlation (p = 0.442). Furthermore, there was a notable association between anxiety in burn patients and factors such as gender, TBSA affected, educational level and the types of burn injuries. Therefore, healthcare providers need to recognize the substantial prevalence of anxiety in burn patients as a fundamental consideration. This recognition should prompt a proactive approach toward early detection and timely intervention. Developing personalized intervention strategies tailored to each patient's unique risk factors and needs is paramount. These strategies may encompass a range of therapeutic options such as counselling, psychotherapy or consultations with mental health specialists.

Relationship between Spiritual Health, Burn Pain Anxiety, and Resilience in Burn Patients

Background and Objective: Burn pain during therapeutic procedures causes anxiety in patients. Spiritual health and resilience are factors affecting anxiety. The present study aimed to determine the relationship between spiritual health with resilience and wound pain anxiety in burn patients. Materials and Methods: In this cross-sectional study, 213 patients were selected by random sampling method. Demographic information, Polotzin and Ellison's spiritual health questionnaire, Connor-Davidson Resilience Scale, and Burns Specific Pain Anxiety Scale were used to collect data. T-tests and one-way analysis of variance were used to analyze the collected data. Data analysis was performed using SPSS software (version 21). Results: The findings showed that most patients were male (62.91%) with an average age of 38.21 ± 12.72. The average scores of spiritual health, wound pain anxiety, and resilience were 73.63 ± 21.20, 52.83 ± 16.18, and 58.24 ± 13.51, respectively. Although a significant relationship was found between spiritual health and resilience and between resilience and wound pain anxiety, no significant relationship was seen between spiritual health and wound pain anxiety. Conclusion: Burn patients suffer a lot of pain during procedures such as dressings. Considering the relationship between spiritual health, burn pain anxiety and resilience, educational workshops are suggested to increase spiritual health, resilience and better tolerance during hospitalization.

Effects of massage therapy on pain and anxiety intensity in patients with burns: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to examine the effects of massage therapy on pain and anxiety intensity in patients with burns. A comprehensive, systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Massage therapy', 'Musculoskeletal manipulations', 'Acute pains', 'Burning pain', and 'Burn' from the earliest to October 17, 2022. Cochran's tool is used to check the risk of bias for randomised clinical trial (RCT) articles. The methodological index for non-randomised studies was used to assess the risk of bias in quasi-experimental studies. STATA version 14 software was used to perform the meta-analysis. A 95% confidence interval (CI) was used to determine statistical significance. Heterogeneity was investigated with I2 . A P-value less than .1 was considered statistically significant for publication bias value. A total of 733 patients with burns were included in seven studies. Five studies had an RCT design and two studies had a quasi-experimental design. The duration of the study was reported in five studies, with a mean of 42.40 weeks. The duration of the intervention was reported in seven studies with a mean of 22.86 minutes. The results of the meta-analysis showed using various types of massage therapy interventions significantly reduced pain intensity in the intervention group compared with the control group (weighted mean difference: -2.08, 95% CI: -2.55 to -1.62, Z= 8.77, I2 : 67.1%, P< .001). Massage therapy intervention significantly reduced the intensity of anxiety in burn patients (standard mean difference: -7.07, 95% CI: -10.13 to -4.01, Z= 4.53, I2 : 98.2, P< .001). Overall, the present systematic review and meta-analysis showed that massage therapy can reduce the intensity of pain and anxiety in burn patients. Therefore, it is recommended that health managers and policymakers pay special attention to massage therapy as a simple, low-cost, and efficient non-pharmacological treatment to relieve pain and anxiety in burn patients.

Effects of aromatherapy with Rosa damascene and lavender on pain and anxiety of burn patients: A systematic review and meta-analysis.

Pain and anxiety were considered the most common complications of treatment procedures in burn patients. Non-pharmacological drugs, including aromatherapy, can decrease these issues. This systematic review and meta-analysis aim to summarise the effects of aromatherapy with Rosa damascene (RD) and lavender on the pain and anxiety of burn patients. A systematic search was performed on international electronic databases such as Scopus, PubMed, and Web of Science, as well as on Iranian electronic databases such as Iranmedex and Scientific Information Database (SID) with keywords extracted from Medical Subject Headings such as "Burns", "Pain", "Pain management", "Anxiety", and "Aromatherapy" were performed from the earliest to November 1, 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist assessed the quality of randomised control trials (RCTs) and quasi-experimental studies. STATA v.14 software was used to estimate pooled effect size. Heterogeneity was assessed with I2 value. Random effect model and inverse-variance method using sample size, mean, and standard deviation changes were applied to determine standard mean differences (SMD). The confidence interval of 95% was considered to determine the confidence level. A total of 586 burn patients participated in six studies, including three RCT studies and three quasi-experimental studies. The results based on RCT studies showed RD significantly decreased the dressing pain average when compared to the control group (SMD: -1.61, 95%CI: -2.32 to -0.99, Z=5.09, I2 : 66.2%, P< 0.001). Aromatherapy with lavender decreased the average pain in the interventional group more than in the control group (SMD: -1.78, 95%CI: -3.62 to 0.07, Z=1.89, I2 : 97.2%, P= 0.06). Using aromatherapy with RD and lavender significantly decreased pain average in the interventional group than the control group (SMD: -1.68, 95%CI: -2.64 to -0.72, Z=3.42, I2 : 94.2%, P= 0.001). The results showed RD significantly decreased the anxiety average in the interventional group than the control group (SMD: -2.49, 95%CI: -2.98 to -2.0, Z=9.94, I2 : 51.6%, P< 0.001). Overall, this study showed that aromatherapy with RD decreased pain and anxiety of dressing procedures in burn patients. Although aromatherapy with lavender decreased pain in the patients, it was not statistically significant. More RCTs studies are required to be able to better judge the effects of aromatherapy with RD and lavender on the pain and anxiety of burn patients.

Effects of breathing exercise techniques on the pain and anxiety of burn patients: A systematic review and meta-analysis.

This systematic review and meta-analysis aim to summarise the effect of breathing exercise techniques (BET) on the pain and anxiety of burn patients during burn care. A systematic search was performed on international electronic databases such as Scopus, PubMed, and Web of Science, as well as on Iranian electronic databases such as Iranmedex and Scientific Information Database (SID) with keywords extracted from Medical Subject Headings such as 'Burns', 'Bandages', 'Pain', 'Pain management', 'Anxiety', 'Breathing', and 'Breathing exercise', which were performed from the earliest to 4 April 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist assessed the quality of randomised control trials (RCTs) and quasi-experimental studies. The current meta-analysis was performed using STATA V.14.0 software. A 95% confidence interval (CI) was used to determine significance levels. Random effect model was used to calculate the weighted mean difference (WMD). A total of 469 burn patients participated in 10 studies. Exactly 58.60% of burn patients were male, and the number of people in the intervention and control groups was equal. The mean age of burn patients was 32.84 (SD= 10.39). Exactly 78.05% of patients had second-degree burns. The mean study duration was 19 weeks. Results of analysis of RCT studies showed BET decreased insignificantly pain severity (WMD: -1.17, 95%CI: -2.54 to 0.21, Z= 1.66, P= .096, I2 :97.1%) in the intervention group than control group. However, the results of non-RCTs studies indicated BET significantly decreased pain (WMD: -1.38, 95%CI: -2.16 to -0.61, Z= 3.49, P< .001, I2 :88.4%) and anxiety (WMD: -4.91, 95%CI: -9.35 to -0.47, Z= 2.71, P= .03 0.001, I2 :88.4%) in the intervention group than control group. Overall, the results of RCTs found BET intervention decreased pain in the intervention group when compared with the control group; however, it was statistically insignificant. Also, results of non-RCT studies showed intervention of BET significantly decreased pain and anxiety in burns patients. More RCTs studies are required for better judgement of the effectiveness of BET intervention in clinical settings.

Meta-analysis of the interventional effects of music therapy on pain and anxiety of burn patients in wound dressing change

Objective: To evaluate the interventional effects of music therapy on pain and anxiety of burn patients in wound dressing change. Methods: The meta-analysis method was adopted. Databases including China National Knowledge Internet, Wanfang Database, and VIP database were retrieved with the search terms in Chinese version of ", , /, /", and PubMed, Embase, and Cochrane Library were retrieved with the search terms in English version of "music, burn, dressing change/wound dressing, pain/ache/sore" to obtain the publicly published randomized controlled trials on the application of music therapy for wound dressing change in burn patients from the establishment of each database to May 2021. The outcome indexes included pain score/percentage and anxiety score after dressing change. Rev Man 5.4 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 520 burn patients from 7 studies were included, including 260 patients in music therapy group who received music therapy and 260 patients in routine dressing change group who received routine dressing change. The bias risk of all the 7 included studies was uncertain. Compared with those in routine dressing change group, the pain percentages (relative risk=0.06, 95% confidence interval=0.01-0.41, P<0.01) and pain scores after dressing change (standardized mean difference (SMD)=-0.91, 95% confidence interval=-1.61--0.22, P<0.05) of patients in music therapy group were significantly lower. Subgroup analysis showed that music type and timing of intervention might be the source of heterogeneity in pain scores after dressing change. The anxiety scores of patients in music therapy group were significantly lower than those in routine dressing change group (SMD=-0.64, 95% confidence interval=-1.09--0.19, P<0.01). There was no publication bias in pain or anxiety scores after dressing change. Conclusions: Music therapy can relieve the pain and anxiety of burn patients during dressing change.

773 Insurance Coverage Does Not Increase Risk of Depression and Anxiety in Burn Patients

IntroductionA burn injury can have long-term mental and physical effects on individual patients. When burn injuries occur at work, there is an additional unfamiliar stress of income loss and dependence on a third-party payer. Patients with claims through the Bureau of Worker’s Compensation (BWC) report frustration and overall dissatisfaction in working with the BWC to achieve claim coverage. Of workers who are off of work more than 5 days due to a work-related injury, 10% are diagnosed with depression in the 12 months following the injury (Carnide, 2016).In our clinic, screening for depression and anxiety is done through the Patient Health Questionnaire (PHQ-4), a valid four-item assessment tool that utilizes a Likert style measurement to assess symptoms of depression and anxiety (Kroenke et al., 2009). This is a health questionnaire that determines a patient’s risk for depression and anxiety as mild, moderate, or severe.ObjectiveTo determine if there is a correlation between insurance type and PHQ-4 scores in burn patients. We hypothesized that risk of depression and anxiety could differ based on payer, which can affect a patient’s access to care, referral approval, and financial burden of treatment. Additional focus was placed on BWC patients due to their reported frustrations and dissatisfaction in working with BWC and the established correlation between depression and missed work.MethodsA quality improvement project was initiated based on increased rates of referrals for psychological evaluation and treatment in BWC patients. A retrospective review was conducted of outpatient burn clinic visits where a PHQ-4 questionnaire was completed in the past 3 fiscal years: 7/1/2019-6/30/2021.ResultsTotal of 1932 visits with PHQ-4 collection were reviewed within the above specified time frame. The rates of moderate and high-risk scores for anxiety and depression were highest with BWC and Medicaid patients. Patients with private insurance showed a lower risk of moderate and severe depression. However, there was no significant difference when comparing BWC verses all other insurance. Table 1ConclusionsOverall there was no significant difference in risk of anxiety and depression with BWC versus other insurance coverage based on PHQ-4 scores. Limitations of the study include no distinction of extent of burn injury/burn depth, burn care/treatments, length of hospital stay if any; no distinction was made amongst BWC patients and their length of time off of work. A portion of the timeframe reviewed was during the COVID-19 pandemic.

Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain: A Systematic Review.

The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions-hypnosis, virtual/augmented reality, and yoga-as supplements to conventional pain regimens for burn management. A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors' inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process. Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.

Comparison of the effect of prayer and ginger on the severity of pain and anxiety in inpatients with burn: Palliative care.

One of the symptoms of burning is chronic and severe pain that affects the quality of life of patients. The aim of this article was to compare of the effect of prayer and ginger on the severity of pain and anxiety in inpatients with burn. This study is a clinical trial study on 120 patients referred to the Burn Ward of Kashani Hospital affiliated to Shahrekord University of Medical Sciences in the southwest of Iran. Patients were randomly divided into three groups: control, prayer and ginger. The visual analogue scale (VAS) was used to determine the severity of pain and the standard measure Spielberger Anxiety Inventory was used to assess anxiety. In this study, group 1 received placebo (starch) capsules (250 mg) daily, group 2 - ginger capsules (250 mg) plus 20 ml water after each meal on a daily basis and group 3 was asked to recite the prayer for 10 minutes three times in the morning, evening and night every day. Data analysis was done by descriptive and inferential statistics (ANOVA and Tukey's test) in the SPSS. After the intervention, the pain levels in the prayer and ginger groups at days 3 and 6 of hospitalization, were lower than the control group. On day 6 mean anxiety level was significantly lower in the prayer group than in the ginger group (P < 0.05). According to the results of this study, it is recommended that using ginger or prayer be applied to reduce the pain and anxiety of burn patients, because they not only cause no side effects but also are low cost, leading to reduction in drug consumption and the resulting side effects.

Aromatherapy for Symptom Relief in Patients with Burn: A Systematic Review and Meta-Analysis.

Background and Objectives: This review aimed to provide an updated review of evidence regarding the effects of aromatherapy in relieving symptoms of burn injuries, focusing on pain and physiological distress. Materials and Methods: Fifteen databases (including five English databases, four Korean medical databases, and four Iranian databases) and trial registries were searched for studies published between their dates of inception and July 2021. Two review authors individually performed study selection, data extraction, and risk of bias assessment, and any discrepancies were solved by a third review author. Results: Eight RCTs met our inclusion criteria and were analyzed in this updated systematic review. Our meta-analyses revealed that inhaled aromatherapy plus routine care showed beneficial effects in relieving pain after dressing, as compared to placebo plus routine care (p < 0.00001) and routine care alone (p = 0.02). Additionally, inhaled aromatherapy plus routine care (p < 0.00001) and aromatherapy massage plus routine care (p < 0.0001) also showed superior effects in calming anxiety, as compared to routine care alone. None of the included studies reported on AEs. Overall, the risk of bias across the studies was concerning. Conclusions: This updated review and synthesis of the studies had brought a more detailed understanding of the potential application of aromatherapy for easing the pain and anxiety of burn patients.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients

BackgroundOne of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients. MethodsThis study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5−10 min before dressing change and 5−10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann–Whitney, Fisher’s exact tests, and paired t-test. The Kolmogorov–Smirnov test was used to check the normality of data. ResultsThe results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days. ConclusionsOur results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

A study comparing the effect of premedication with intravenous midazolam or dexmedetomidine on ketamine-fentanyl sedoanalgesia in burn patients: A randomized clinical trial

IntroductionDressing changes and wound care-debridement procedures often cause fear and anxiety in burn patients, as these processes are quite painful. In order to determine the best method for alleviating pain during these procedures, the current study compared the efficacy and safety of intravenous dexmedetomidine and midazolam for premedication prior to these painful burn care procedures. MethodsThis comparative and randomized study included patients who had a burn size of 1563%, were aged 1870 years, were diagnosed with the American Society of Anesthesiologists physical status (ASA I–II), and who underwent painful burn care procedures. Patients were intravenously administered either 1 mcg/kg dexmedetomidine (Group 1) or 0.03 mg/kg midazolam (Group 2) prior to the burn care procedure. Recorded at predetermined time points for each patient were heart rhythm (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), standard bispectral index (BIS), and Ramsay Sedation Scale (RSS). ResultsIn the dexmedetomidine group, HR and MAP measurements of patients ​​at the 3rd, 5th, and 10th mins during sedation were significantly lower than the baseline values (p < 0.05). A significant decrease in SpO2 was observed in both groups at the 10th min during sedation, but the decline was higher in the midazolam group (p < 0.05). BIS measurements of the patients in both groups were significantly lower at 10 min. during sedation and at 15th and 60th mins during the procedure (p < 0.05). However, there was no significant difference between the group (p > 0.05). The RSS scales of both groups in during the sedation were higher in the 3rd, 5th and 10th mins than the baseline values (p < 0.05), but there was no significant difference between the groups (p > 0.05). The RSS scales of groups in during the burn procedure were significantly higher at 15 th min than the 0 th values, while the RSS scales of both groups were significantly lower in the 45th and 60th mins (p < 0.05). ConclusionResults of this study indicate that dexmedetomidine causes hemodynamic alterations while midazolam causes respiratory depression. However, these effects are not severe, and we conclude that both agents are safe and effective to ensure sedation prior to painful burn-care procedures.

The effect of inhalation aromatherapy with damask rose essence on pain intensity and anxiety in burned patients: A single-blind randomized clinical trial

IntroductionPain and anxiety are a major problem of burn patients. Despite the use of different medications, patients still suffer from these two problems. Aromatherapy along with medication may help in alleviating these symptoms. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients. MethodsThis three group clinical trial was conducted on 120 patients with burns less than 30% TBSA. The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no intervention. ResultsBaseline state–trait anxiety and pain intensity were similar in these three groups (p > 0.05). We found a significant reduction in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups (p < 0.001). However, we found no significant difference between the placebo and control groups in terms of these variables at these times (p > 0.05). Also, we found no significant difference among three groups in frequency of analgesics drugs and trait anxiety after intervention (p > 0.05). ConclusionInhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.

Comparison of the effects of inhalation aromatherapy using Damask Rose aroma and the Benson relaxation technique in burn patients: A randomized clinical trial

BackgroundBurn injuries are often accompanied by painful and distressing consequences, which can lead to long-term psychological issues. The most common form of anxiety in burn patients is pain anxiety. It is described as the feeling of fear and pain prediction caused by painful procedures. AimTo compare the effects of inhalation aromatherapy using damask rose aroma and the Benson relaxation technique on pain anxiety in burn patients. MethodsThis randomized clinical trial was conducted on 132 patients hospitalized in Motahari Burn Hospital from October 2017 to March 2018. The subjects were selected using a sequential sampling method. Next, they were randomly allocated by the Permuted block randomization method into four groups of rose aroma (5 drops of 40% rose aroma), the Benson relaxation technique, combined rose aroma-Benson relaxation and control. The interventions were performed for three consecutive days and once a day for 20 min, and each session lasted from 45 to 30 min before the daily dressing change. Data was collected using the Persian version of burn specific pain anxiety scale (BSPAS). Data was analyzed using descriptive and inferential statistics via the SPSS software version 16. ResultsImmediately after the intervention, on the first, second and third days, significant differences in pain anxiety among four groups were reported. On the first day, the Scheffé ad hoc test indicated statistically significant differences in pain anxiety between all groups (p < 0.001), except rose aroma-plus-Benson relaxation and rose aroma groups (p = 0.15). On the second and third days, there were significant differences between the groups in pain anxiety (p < 0.001). Furthermore, after wound dressing, on the first, second and third days, statistically significant differences in pain anxiety among four groups were reported. On the first day, the Scheffé ad hoc test revealed statistically significant differences in pain anxiety between all groups (p < 0.001). On the second and third days, there were statistically significant differences in pain anxiety between the groups (p < 0.001), except the rose aroma and Benson relaxation groups. Immediately after the intervention, the maximum effect size was on the first day in the group of rose aroma-plus-Benson relaxation and the lowest effect size was on the first day in the Benson relaxation group. However, after wound dressing, the maximum effect size was on the third day in the rose aroma-pus-Benson relaxation group and the lowest effect size was on the first day in the Benson relaxation group. ConclusionThe combination of the rose aroma and Benson relaxation has a synergistic effect and has more effects in the reduction of pain anxiety in burn patients than a single intervention. Health care providers can provide these interventions simultaneously and help reduce pain anxiety in burn patients before conducting painful interventions.

The Effect of Inhalation Aromatherapy with Lavender Essence on Pain Intensity and Anxiety in Burn Patients: A Clinical Randomized Trial

The Effect of Inhalation Aromatherapy with Lavender Essence on Pain Intensity and Anxiety in Burn Patients: A Clinical Randomized Trial

Comparing the effect of patients preferred music and Swedish massage on anticipatory anxiety in patients with burn injury: Randomized controlled clinical trial

BackgroundEffective strategies should be considered for reducing pain and anxiety and improving burn patients' well-being. This study was aimed to compare the effect of preferred music and Swedish massage on pain anticipatory anxiety in burn patients. MethodsIn this randomized controlled clinical trial 240 hospitalized burn patients were selected and assigned to Swedish massage, preferred music, combination of Swedish massage and preferred music and control groups through fixed blocking randomization. Interventions was offered before wound care one time for 20 min on patients' bedside. Patients in the control group only received routine care. The Persian version of Burn Specific Pain Anxiety Scale were used for data gathering. Data was analyzed using SPSS-PC (V.16.0). ResultsThere was a statistically significant difference between groups regarding mean changes of anticipatory anxiety (P < 0.001). The results indicated that patients in the group of combination of both interventions reported significantly lower anticipatory anxiety as compared to the preferred music (P = 0.015), Swedish massage (P = 0.002) and control (P < 0.001) groups. The mean changes of anticipatory anxiety score in the Swedish massage and preferred music groups had a statistically significant difference with the control group (P < 0.001). There was no difference between the mean changes of anticipatory anxiety in preferred music and Swedish massage groups. ConclusionsAccording to the results, combining both Swedish massage and preferred music was more effective in reducing anticipatory anxiety in burn patients. Health care providers, particularly, nurses can provide these two noninvasive and economical interventions simultaneously and benefits the synergistic effect of them in burn patients.

Effect of transcranial direct current stimulation on pain anxiety during burn wound care

BackgroundChanges in neuronal activity by cathodal transcranial direct current stimulation (tDCS) of the sensory cortex can relieve acute pain. Studies have demonstrated high correlation between burn pain and anxiety in burn patients. The aim of this study was to assess the effect of tDCS on pain anxiety in patients with severe burn. MethodsIn a controlled randomized clinical trial, 60 subjects who were hospitalized during the year 2014 in the Department of Burn and Reconstructive Surgery of Imam Reza Hospital of Mashhad were selected as the sample for this study. The patients were randomly assigned to one of the two groups. A cathodal stimulation group that received real 1.0mA tDCS over sensory cortex lasted 20min and the control group received sham tDCS. Pain anxiety was obtained by self-report pain anxiety questionnaire before and after stimulation. It was also completed immediately after burn dressing. The data were analyzed by performing the Chi-square, Fisher's exact, independent samples t, paired samples t, Mann-Whitney and Wilcoxon tests using SPSS 11.5 software. ResultsPain anxiety score reduced significantly in the real tDCS compared with sham group (23.4±3.8 versus 29.3±2.0, p≤0.001). After stimulation there was a decrease in pain anxiety score in real tDCS group (p=0.010). ConclusionAccording to our study, cathodal cortical stimulation with tDCS is associated with significant reduction in pain anxiety in burn patients.

The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach.