Determinants of pain expression in hospitalized burn patients.

This study examines the relationship between extent of injury, degree and type of psychological distress and self-report of pain in burn survivors. One hundred eighty burn patients were interviewed within 2 weeks of their burn trauma. Using a visual analogue scale to assess subjective pain and pain relief, and self-report measures of post-traumatic stress symptoms and general psychological distress, we assessed the relationship between PTSD symptoms, general distress and pain. Subjective pain was unrelated to sex, ethnicity, or total body surface area burned. The most important correlate of subjective pain was general psychological distress. Intrusive PTSD symptoms had no independent power to predict the variance in pain scores. However, among women, more severe avoidant symptoms were associated with greater subjective pain.

Predictors of posttraumatic stress disorder after burn injury.

OBJECTIVE: The authors' goal was to examine subjective and objective predictors of posttraumatic stress disorder (PTSD). METHOD: Hospitalized burn patients were assessed 1 week after injury with both objective predictors (percent of burned area and facial disfigurement) and subjective predictors (emotional distress and perceived social support). The patients were then assessed 2, 6, and 12 months later for development of PTSD. RESULTS: Among 51 patients, 18 (35.3%) met PTSD criteria at 2 months. High rates of PTSD were also found at 6 months (N = 16, 40.0% of the 40 available patients) and 12 months (N = 14, 45.2% of the 31 available patients). PTSD was predicted by subjective variables assessed at baseline, but patients with more severe burns were not more likely to develop PTSD. CONCLUSIONS: The DSM-III-R diagnosis of PTSD relies on an objective evaluation of the stressor's severity. The prospective data in this study support those who argue that evaluations of the severity of the stressor might also take into account subjective factors.