20 Assessing Mental Health’s Impact on Pain and Itch Perception in Post-Burn Hypertrophic Scars

TL;DR

This study found that burn patients with mental health diagnoses experienced greater improvements in pain and itch after laser therapy compared to those without such diagnoses.

Contribution

The study reveals that mental health interventions may enhance post-burn scar perception outcomes during laser therapy.

Findings

Mental health disorder (MHD) patients showed significant decreases in pain and itch scores after laser therapy sessions.

NoMH patients only showed pain improvement at the final laser session, while MHD patients improved earlier.

Observer-reported scar healing scores showed no differences between groups, suggesting psychological factors influence perception.

Abstract

Burn injuries often result in hypertrophic scars (HTS) associated with pain and itch (P&I). Laser scar revision (FLSR) has become a popular adjunct to existing treatments for HTS, yet some patients continue to experience P&I, severely impairing quality of life.

Mental health disorders can greatly impact patient perception of P&I. This study assessed the influence of mental health on P&I perceptions in post-burn FLSR patients, hypothesizing that patients with no mental health diagnosis would improve more rapidly than those with a diagnosis during laser therapy.

Demographics (age, sex, Fitzpatrick skin type, race) and scar characteristics (scar age, burn etiology, location, size) were obtained. Patients (n=110) were split into two cohorts, those with no mental health diagnosis, (NoMH, n=53) and those with (MHD, n=57). Inclusion in MHD required a preexisting diagnosis or one from inpatient burn psychology. All patients received a preoperative evaluation (pre-FLSR), at least 3 treatments (FLSR 1, 2, 3) and evaluation via patient and observer scar assessment scale (POSAS) -observer(-O), and -patient(-P). All P&I scores were obtained from the POSAS-P evaluations.

Intergroup comparisons between P&I scores and FLSR sessions were not significant. However, intragroup analysis of MHD revealed significant decreases in pain between pre-FLSR and post-FLSR session 1 (p< 0.001), FLSR 2 (p< 0.05) and FLSR 3 (p< 0.01). In NoMH the only decrease was from pre-FLSR and FLSR 3 (p< 0.01). Itch scores decreased in MHD post-FLSR 2 (p <.05) and FLSR 3 (p <.001) compared to pre-FLSR. NoMH had no differences between pre- and post-laser itch. There were no differences between group POSAS-O average scores. For NoMH, there were decreased scores at post-FLSR 2 (p< 0.01) and FLSR 3 (p< 0.001) and in MHD at post-FLSR 2 (p< 0.001) and FLSR 3 (p< 0.0001). There were no significant differences in concomitant medications between the MHD and NoMH groups except related to SSRIs.

Contrary to the hypothesis, MHD patients reported a more significant decrease in P&I throughout FLSR treatment compared to NoMH. This is despite POSAS-O scores demonstrating no differences between groups in observer-reported scar healing and suggests a factor outside of scar healing impacts P&I perception.

Interventions implemented by the burn psychology team are a likely cause of the improved scar perception in MHD patients. The data further shows the importance of a dedicated burn psychology team and warrants further studies on the influence of psychological support on post-burn patient outcomes in the setting of laser.

This work was funded in part by the National Center for Advancing Translational Science (NCATS/NIH)