***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study sought to compare the analgesic efficacy and safety of patient controlled intra-nasal ( PCIN ) fentanyl with oral morphine for procedural wound care in burns patients . A r and omised double-blind placebo controlled , two period , two-treatment crossover trial was conducted within the Burns Unit of a major teaching hospital in Perth , Western Australia . Patients requiring identical wound care procedures on two consecutive mornings ( and not prescribed intravenous analgesia ) were r and omised to receive either PCIN fentanyl with oral placebo or oral morphine with intranasal placebo on 1 day , followed by the alternate active drug on the following day . Twenty-six patients ( 22 males ) , aged between 18 and 69 years ( 35.5 + /- 12.4 years ) , with total body surface burns ( TBSA ) range 1 - 25 % ( 6.9 + /- 4.5 ) , indicated their level of pain on a 10 point ( 0 - 10 ) numeric scale at various time periods before , during and after the procedure . A mean total dose of 1.48 + /- 0.57 microg/kg of PCIN fentanyl and 0.35 + /- 0.12 mg/kg of oral morphine was administered . No statistically significant difference was found between the pain scores recorded for patients during the procedure with PCIN fentanyl compared to that with oral morphine ( mean difference = -0.75 , 95 % CI = -1.97 to 0.47 , P = 0.22 ) . Two patients experienced hypotension during the procedure -- both had received active oral morphine . No patients experienced respiratory depression or a significant drop in oxygen saturation . There were four episodes ( in three patients ) where ' rescue analgesia ' for severe pain was required -- two episodes involving oral morphine and two involving PCIN fentanyl . It was concluded that PCIN fentanyl is similar in efficacy and safety to oral morphine for relief of procedural wound care pain in burns patients A prospect i ve study was design ed to compare two psychological support interventions in controlling peri-dressing change pain and anxiety in severely burned patients . Thirty patients with a total burned surface area of 10 - 25 % , requiring a hospital stay of at least 14 days , were r and omised to receive either hypnosis or stress reducing strategies ( SRS ) adjunctively to routine intramuscular pre-dressing change analgesia and anxiolytic drugs .  Visual analogue scale ( VAS ) scores for anxiety , pain , pain control and satisfaction were recorded at 2-day intervals throughout the 14-day study period , before , during and after dressing changes . The psychological assistance was given on days 8 and 10 after hospital admission . The comparison of the two treatment groups indicated that VAS anxiety scores were significantly decreased before and during dressing changes when the hypnotic technique was used instead of SRS . No difference was observed for pain , pain control and satisfaction , although VAS scores were always better in the hypnosis group . The study also showed that , overall , psychological support interventions  reduced pain and increased patient satisfaction . These results confirm the potential benefits of psychological assistance during dressing changes in burned patients This prospect i ve study evaluated the efficacy and safety of IV ibuprofen for the reduction of fever and treatment of pain in patients with thermal burn injury . A total of 61 patients with second- and /or third-degree thermal burns covering > 10 % TBSA were r and omly assigned in a 2:1 ratio to receive either 800 mg IV ibuprofen or placebo every 6 hours for 120 hours ( 5 days ) . Antipyretic medications were restricted during the first 24 hours of the study , but analgesics were allowed throughout . The primary efficacy endpoint was area under the curve for temperature ( AUC-T ° ) within the first 24 hours of treatment . After 24 hours of dosing , there was a significant reduction in temperature in patients who received IV ibuprofen compared with those who received placebo ( P = .008 ) . The temperature remained reduced over the entire 120-hour dosing period in the patients who received IV ibuprofen , although the difference beyond 24 hours did not reach statistical significance . Because of enrollment of patients unable to perform self- assessment s of pain , an inadequate number of patients were enrolled to detect differences in pain scores . There was no significant difference in the incidence of serious adverse events . Fever was reduced significantly by IV ibuprofen in burn patients over the initial 24-hour dosing period and remained reduced throughout the dosing period . Exposure to the maximum daily recommended dose of 3200 mg ( 800 mg every 6 hours ) for a total of 120 hours ( 5 days ) was well tolerated This study tested the efficacy of 2 brief cognitive interventions in supplementing regular medical treatment for pain during burn dressing change . Forty-two burn in patients were r and omly assigned to 3 groups : sensory focusing , music distraction , and usual care . Patients reported pain , pain relief , satisfaction with pain control and pain coping strategies . The sensory focusing group reported greater pain relief compared to the music distraction group and a reduction in remembered pain compared to the usual care group , although group differences were not observed on serial pain ratings . In addition , after controlling for burn size and relevant covariates , regression analyses indicated that catastrophizing predicted pain , memory for pain , and satisfaction with pain control . Refinement of the sensory focusing intervention is warranted to reduce catastrophic thinking and improve pain relief Background : The adverse consequences of burn injuries include pain and psychological distress , which show bidirectional associations . However , much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression . Purpose : The purpose is to assess the prospect i ve effects of anxiety and depression on pain and functional outcomes following burn injury . Methods : This article describes a 2-year cohort study in patients hospitalized for serious burn injuries ( assessment s at discharge and 6-month , 1-year , and 2-year follow-up ) . Linear mixed effects analyses were conducted to model anxiety and depression ’s unique longitudinal effects ; at each time point , depressive and anxiety symptoms were studied as predictors of subsequent changes in pain , fatigue , and physical function . Results : When studied in separate prediction models , both depression and anxiety were strong prospect i ve predictors of greater pain , more fatigue , and physical dysfunction at the subsequent time point ( ps<.01 ) . However , when both were included in a single model to study their unique effects , depressive symptoms ( but not anxiety ) emerged as a signfiicant predictor of subsequent increases in pain and reductions in physical functioning , whereas anxiety ( but not depression ) predicted subsequent elevations in fatigue . Conclusions : These findings suggest potentially distinct effects of depression and anxiety and imply that assessment and early treatment of both depressive and anxiety symptoms may help improve a broad range of long-term pain-related outcomes following burn inury & NA ; This r and omised , double‐blind , placebo‐controlled trial assessed the efficacy and tolerability of pregabalin to alleviate the neuropathic component of moderate to severe burn pain . Patients aged 18 to 65 years admitted to a burns unit with a 5 % or greater total body surface area burn injury were screened to participate in the trial . Using the Neuropathic Pain Scale ( NPS ) , patients scoring 4 or higher on ‘ hot ’ pain or ‘ sharp ’ pain were invited to participate . Consenting patients were r and omly assigned to receive pregabalin or placebo for 28 days with individual dose titration commencing at 75 mg twice daily to a maximum pregabalin dose of 300 mg twice daily . The primary outcome measure was the patients ’ daily response to the sharp and hot pain of the NPS . Secondary outcome measures included the remaining elements of the NPS , daily opioid requirement , length of hospital stay , pain at 6 months , and side effects of nausea , vomiting , drowsiness and giddiness . For patients administered pregabalin , the primary outcome measures hot ( P = .01 ) and sharp ( P = .04 ) pain were significantly reduced compared with those in patients administered placebo . Secondary outcome measures of itch , unpleasantness , surface pain , and procedural pain were significantly lower ( P < .05 ) in the pregabalin group . Adverse effects were uncommon , with no difference between the treatment groups . There was no significant difference between the pregabalin and placebo treatment groups with respect to opioid consumption , duration of hospital stay , or pain at 6 months . Pregabalin was efficacious and well tolerated in patients after severe burn injury and whose pain was characterised by features of acute neuropathic pain . In this study , pregabalin was well tolerated and significantly reduced several elements of the neuropathic pain scale including hot pain , unpleasantness of the pain , surface pain , and itch , and also significantly reduced procedural pain Pain and anxiety are well-documented problems during the rehabilitation of patients with burns . This study examined the effect of music on anxiety and pain during range of motion .  Eleven subjects with partial-thickness or deeper burns were r and omly assigned to a control group ( without music intervention ) or experimental group ( with music intervention ) .  Vital signs , pain , and anxiety were recorded before and after treatments . There was no difference in pretest and posttest anxiety across the groups ; however , there was a difference in anxiety between the groups . Conversely , there was a difference in pretest and posttest pain across the groups but no difference in pain between the groups . Results showed no significant reduction in anxiety and pain during therapy with music relaxation . Limitations included nonhomogenous groups , small sample size , potentially unrepresentative sample , variation in exercise protocol , and small musical selection . Further research is recommended Burn patients must often endure intense pain during their regular dressing changes . The aim of the present study was to investigate the therapeutic effect of rapid induction analgesia ( RIA ) on resting and procedural pain , anticipatory anxiety , relaxation levels and medication consumption in 30 hospitalized burn patients . Patients rated levels of pain and relaxation for four burn care sessions . RIA was conducted twice on 15 patients , whereas dressing changes proceeded as usual in 15 control patients . When asked to recall pain during the dressing changes , patients remembered an experience which was worse in its entirety than the average of spot ratings taken during the burn care procedure . However , self-reported ratings of the sensory and affective components of pain decreased significantly during and after RIA , particularly in patients who became readily absorbed , and relaxation increased during burn care . Anticipatory anxiety decreased before dressing changes in the RIA group , and analgesic intake decreased between treatment sessions . The promising outcome of this study confirms RIA as a viable adjunct to narcotic treatment for pain control during burn care The purpose of this single-blinded r and omized clinical trial was to determine whether therapeutic touch ( TT ) versus sham TT could produce greater pain relief as an adjunct to narcotic analgesia , a greater reduction in anxiety , and alterations in plasma T-lymphocyte concentrations among burn patients .  Therapeutic touch is an intervention in which human energies are therapeutically manipulated , a practice conceptually supported by Rogers ' ( 1970 ) theory of unitary human beings . Data were collected at a university burn centre in the south-eastern United States . The subjects were 99 men and women between the ages of 15 and 68 hospitalized for severe burns , and they received either  TT or sham TT once a day for 5 days . Baseline data were collected on day 1 , data were collected before and after treatment on day 3 , and post-intervention data were collected on day 6 . Instruments included the McGill Pain Question naire , Visual Analogue Scales for Pain , Anxiety and Satisfaction with Therapy , and an Effectiveness of Therapy Form . Blood was drawn on days 1 and 6 for lymphocyte subset analysis . Medication usage for pain in mean morphine equivalents , and mean doses per day of sleep , anxiety and antidepressant medications were recorded . Subjects who received TT reported significantly greater reduction in pain on the McGill Pain Question naire Pain Rating Index and Number of Words Chosen and greater reduction in anxiety on the Visual Analogue Scale for Anxiety than did those who received sham TT . Lymphocyte subset analyses on blood from 11 subjects showed a decreasing total CD8 + lymphocyte concentration for the TT group . There was no statistically significant difference between groups on medication usage Abstract Benzodiazepines are commonly used to supplement opioid analgesics in treating procedural pain during the treatment of major burn injuries . To date , no study has investigated whether benzodiazepines actually have an analgesic or anxiolytic effect in such circumstances . Seventy‐nine patients admitted to a major regional burn center were r and omly assigned to groups that received 1 mg of lorazepam or a placebo in addition to their st and ard opioid analgesics . A strong analgesic effect of lorazepam was not observed when treatment groups were compared independent of their baseline pain ratings . However when patients who had high baseline pain were compared , lorazepam result ed in a significant reduction in pain ratings ( adjusted post‐treatment VAS mean score=54.28 ; adjusted control VAS mean score=69.06 ) . Trait anxiety did not predict those patients who had an analgesic effect with lorazepam , but state anxiety did prove to be a covariate with visual analogue score decreases in pain reports The authors examined ratings on a scale of pain-related anxiety in 173 burn patients in three groups : patients with small burns , patients with moderate burns and patients with extensive burns . The data suggest a greater degree of anxiety during procedures and before procedures in the burn patients with extensive burns than in burn patients with small and moderate burns . This study introduces a novel measure of pain-related anxiety in clinical burn patients , the abbreviated  Burn Specific Pain Anxiety Scale ( BSPAS )  , which showed a high degree of reliability . The alpha coefficients were high for the BSPAS subscales Pain management during burn dressing changes is a critical part of treatment in acute burn injuries . Although several treatment options have been suggested , it is still a challenge 
    Output:
    
Unidimensional pain assessment tools  were most frequently used pain assessment tools , with multidimensional tools used less often , despite the multifaceted and complex nature of burn pain .
The review highlights the lack of consistency of  pain assessment tool use in r and omized clinical trials with respect to managing burn pain .