title: 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.
  
  
  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.affiliation: *Department of Surgery, University of North Carolina, Chapel Hill §Wake Forest Baptist Medical Center, Winston-Salem, NC †Washington Hospital Center, Washington, DC ‡Crozer Chester Medical Center, Upland, PA.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Orrey
authors.forename: Omar I
authors.initials: OI
authors.lastname: Halawa
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Bortsov
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Shupp
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Jones
authors.forename: Linwood R
authors.initials: LR
authors.lastname: Haith
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Hoskins
authors.forename: Marion H
authors.initials: MH
authors.lastname: Jordan
authors.forename: Shrikant I
authors.initials: SI
authors.lastname: Bangdiwala
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Roane
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
authors.forename: James H
authors.initials: JH
authors.lastname: Holmes
authors.forename: James
authors.initials: J
authors.lastname: Hwang
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000188:drug therapy; D002394:Catechol O-Methyltransferase / Q000235:genetics*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000235:genetics; D010147:Pain Measurement; D010349:Patient Compliance / Q000523:psychology; D010865:Pilot Projects; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D011433:Propranolol / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol; C588010:COMT protein, human; D002394:Catechol O-Methyltransferase
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