[NEW ANALGESIC PROTOCOL FOR THE TREATMENT OF PAIN AND ANXIETY IN PEDIATRIC BURN PATIENTS - DEVELOPMENT, IMPLEMENTATION AND FIRST RESULTS].

INTRODUCTION: Burns are one of the most common and painful injuries among babies and children. The pain endured during and in between treatment can be minimized with sedation. These sedations, however, are not without side effects and risks. Given the potential complications, we devised a Burn Analgesic Treatment Protocol that incorporates safe analgesia during burn treatment and throughout the day, thus minimizing the necessity for sedations. AIMS: Assessment of the effectiveness of the analgesic protocol by quantification of overall number of sedations needed for burn treatment and by assessment of the overall experience of the treating medical team exposed to burn care before and after implementation of the protocol. METHODS: A retrospective analysis of analgesic treatment regimens among admitted pediatric burn patients both before and after the implementation of our analgesic protocol was performed. Furthermore, questionnaires were given to the nurses of the treating medical team in order to better assess overall experience with the new analgesic protocol. RESULTS: A total of 87 patients were treated with the new analgesic protocol and 46 patients served as the control group. A significantly lower number of sedations were performed in the group treated with the new protocol compared to the control group (18% vs 30%, p=0.057). The questionnaires filled out by the treating nurses revealed an average score of 4.5 (between 1 - 5), indicating high satisfaction with the protocol. CONCLUSIONS: Our new analgesic protocol allows for highly effective treatment of burn wounds while minimizing the necessity for sedations, thus increasing overall patient safety and reducing potential complications.

The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study.

OBJECTIVES: The objective of this prospective, open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in participants with treatment-resistant chronic pain. PATIENTS AND METHODS: The primary outcome was the change in the pain symptom score on the S-TOPS (Treatment Outcomes in Pain Survey-Short Form) questionnaire at the 6-month follow-up in an intent-to-treat population. Secondary outcomes included the change in S-TOPS physical, social, and emotional disability scales, the pain severity, and pain interference on the Brief Pain Inventory, sleep problems, and the change in opioid consumption. RESULTS: A total of 274 participants were approved for treatment; complete baseline data were available for 206 (intent-to-treat), and complete follow-up data for 176 participants. At follow-up, the pain symptom score improved from median 83.3 (95% confidence interval [CI], 79.2-87.5) to 75.0 (95% CI, 70.8-79.2) (P<0.001). The pain severity score (7.50 [95% CI, 6.75-7.75] to 6.25 [95% CI, 5.75-6.75]) and the pain interference score (8.14 [95% CI, 7.28-8.43] to 6.71 [95% CI, 6.14-7.14]) improved (both P<0.001), together with most social and emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001). Serious adverse effects led to treatment discontinuation in 2 participants. DISCUSSION: The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and a significant reduction in opioid use. Results suggest long-term benefit of cannabis treatment in this group of patients, but the study's noncontrolled nature should be considered when extrapolating the results.