Current Status And Influencing Factors Of Pain Catastrophizing In Burn Patients During Hospitalization

ObjectiveTo investigate the status quo of pain catastrophizing in burn patients during hospitalization,analyze its influencing factors,and explore in depth the pain experiences and the related experiences that lead to the perception of pain catastrophizing in burn patients with pain catastrophizing during hospitalization to provide a reference for the future development of scientific clinical burn pain management plans.MethodsA mixed method was adopted in this investigation.The first component was quantitative research,and the second component was qualitative research:(1)Quantitative research: Based on the cross-sectional study method,327 inpatients in the burns department of a Class Ⅲ Grade A hospital in Lanzhou from December 2021 to January 2023 were selected by convenience sampling for a questionnaire survey.The research instruments included the general information questionnaire,Pain Catastrophizing Scale(PCS),Numeric Rating Scales(NRS),Burn Specific Health Scale-Brief(BSHS-B),Hospital Anxiety and Depression Scale(HADS),The PTSD Checklist-Civilian Version(PCL-C),Social Support Rating Scale(SSRS),Family APGAR Index(APGAR).Excel and SPSS26.0 were used for data analysis.Descriptive statistical analysis was carried out using frequency,rate,ratio,and mean ± deviation(?X±S);independent sample t test,analysis of variance,Pearson correlation analysis,and multiple linear regression were used for analyzing influencing factors.(2)Qualitative research: Based on the exploratory research design,through the purpose sampling,using the most differential sample strategy,10 burn inpatients with pain catastrophizing were selected for semi-structured interviews from a prior quantitative study of a questionnaire survey of 327 burn inpatients.Employing the researchers themselves as research instruments,and the proposal for the interview was developed based on literature reviews and quantitative research findings.The data from the interviews were evaluated using content analysis.Results(1)Quantitative research: A total of 327 burn patients with an average age of(43.96±14.89)were investigated,comprising 212 males and 115 females.The descriptive analysis revealed that the average total PCS score of burn patients during hospitalization was(25.65±10.24).The average score of three dimensions was: the ruminant dimension was(8.70 ± 3.01),the exaggerated dimension was(6.56 ± 2.71),and the helplessness dimension was(10.40±5.25).Taking the total PCS score≥30 as the critical value of pain catastrophizing,the incidence of pain catastrophizing in burn patients during hospitalization was 36.1%.According to univariate analysis,marital status,place of residence,medical payment method,cause of the burn,degree of burn,site of the burn,and inhalation injury,were significantly different from PCS total score and one or more dimensions(P < 0.05).Pearson correlation analysis revealed that age,BMI,health status,social support,and family support were negatively correlated with total PCS score and one or more dimension score,and that total body surface area(TBSA),degree of pain,anxiety,depression and PTSD symptoms were positive correlated with the total PCS score and one or more dimension scores with statistically significant differences(P < 0.05).Multivariate analysis showed that site of the burn,NRS,BSHS-B,PTSD symptoms,and anxiety were the main factors affecting the total PCS score in burn patients(P < 0.05).The site of the burn,NRS,PTSD symptoms,and anxiety were the main factors affecting the ruminant dimension in burn patients(P <0.05).Medical payment method,inhalation injury,NRS,BSHS-B,and PTSD symptoms were the main factors affecting the exaggerated dimension in burn patients(P < 0.05).Inhalation injury,NRS,BSHS-B,PTSD symptoms,and anxiety were the main factors affecting the helplessness dimension in burn patients(P < 0.05).(2)Qualitative research: This study interviewed 10 burn patients with pain catastrophizing during hospitalization,numbered N1-N10 in order,encompassing 5males and 5 females with an average age of(39.5±12.75).Thematic analysis of patients’ experience of pain and related experiences that led to their pain catastrophizing cognition resulted in 5 themes and 13 sub-themes.The first theme was profound pain experience(extreme and severe pain,dynamic pain experience,and dressing change discomfort).The second theme was different coping techniques(positive and negative).The third theme was a heavy psychological burden(anxiety in the face of pain,posttraumatic stress disorder,inability to control temper).The fourth theme was an impaired daily life and social interaction(physical activity restriction,pain interfering with sleep,and social activity restriction).The fifth theme was pain treatment expectations(expectations on medical and nursing techniques,information needs).Conclusion(1)The prevalence of pain catastrophizing in hospitalized burn patients was high,and the pain was predominantly severe and intense.The status quo was not optimistic.(2)Pain catastrophizing in hospitalized burn patients was most influenced by the intensity of pain,the site of the burn,the patient’s health status,anxiety,PTSD symptoms,and family and social support.It is suggested that in clinical practice,medical and nursing staff should pay attention to the level of pain catastrophizing in burn patients during hospitalization,focus on patients with severe pain and apparent physical dysfunction,assess patients’ psychological states,provide psychological counseling for patients with anxiety,depression,and PTSD,and encourage and support patients with low family and social support.Customized intervention measures are developed based on the influencing elements of various aspects.(3)Burn patients with pain catastrophizing have varied pain experiences during their hospitalization,and the related experiences that led to their pain catastrophizing cognition mainly manifested as deep pain experience,different pain coping strategies,severe psychological burden,impaired daily and social life,and pain treatment expectations.Multimodal approaches should be used to lessen pain catastrophizing in patients based on their conditions and improve patients’ pain outcomes.