Examining the role of post-traumatic stress disorder, chronic pain and opioid use in burn patients: A multi-cohort analysis
Authors: Lewis Joshua , Pride Lornee C , Lee Shawn , Anwaegbu Ogechukwu , Tabukumm Nangah N , Patel Manav M , Lee Wei-Chen 
Published: December 2024

Introduction Burns are associated with a high risk of developing comorbidities, including psychiatric disorders such as Post-Traumatic Stress Disorder (PTSD). This study aimed to evaluate the association between PTSD and opioid use, chronic pain syndrome, and other outcomes following burn injuries. Methods A retrospective case-control analysis was conducted using the TriNetX database, a federated, de-identified national health research network with 92 healthcare organizations across the United States. Burn patients with and without PTSD were identified and matched based on demographics and injury severity. The likelihood of opioid use and other outcomes, including chronic pain, depression, anxiety, and emergency department visits, were compared between cohorts. Our study examined eight cohorts based on the percentage of total body surface area burned (TBSA%) and the presence or absence of PTSD. These cohorts were stratified as follows: patients with or without PTSD with TBSA, 1–19%, 20–39%, 40–59%, and 60+%. This stratification enabled a detailed comparison of outcomes across different levels of burn severity and the presence of PTSD, providing a comprehensive context for the results. Results The mean age of patients with PTSD was slightly higher (46 ± 16 years) than that of those without PTSD (43 ± 23 years). Incidence of PTSD ranged from 4.96 to 12.26%, differing by percentage of total body surface area burned (TBSA%). Significant differences in various complications and comorbidities were observed between patients with and without PTSD within each burn severity cohort. Compared to the patients without PTSD, patients with PTSD had a significantly higher risk of opioid use in all cohorts: TBSA 1–19%, 20–39%, 40–59%, and 60+%. Conclusion PTSD is associated with a significant increased likelihood of adverse outcomes following severe burns, particularly opioid use, chronic pain, psychological disorders, and higher healthcare utilization. These findings underscore the importance of identifying PTSD in burn patient management and highlight the need for further research into postoperative pain management strategies for this vulnerable population. Psychological assessments and cognitive behavioral therapy may be particularly useful. Lay Summary Burn injuries can cause serious problems like infections and organ failure, and they sometimes lead to death. Severe burns affect about 4.4% of all burn cases and can be deadly in nearly 18% of those cases. They cause inflammation that can lead to long-term heart, metabolism, and thinking problems. These injuries can also cause mental health issues like PTSD (Post-Traumatic Stress Disorder). PTSD means people might relive their trauma through bad memories or nightmares, avoid thinking about it, and feel different emotions for at least a month after it happens. People who survive burns often get PTSD because the injury is so traumatic and takes a long time to heal. Between 2% and 30% of burn survivors might feel very stressed soon after, and up to 40% could have PTSD within six months. People with PTSD from burns often also have depression and anxiety because recovering and going back to normal life is tough. Doctors often give strong painkillers called opioids to burn patients, but they can be very addictive. People with PTSD and opioid problems often also have other mental health issues. A study in 2023 found that 80% of burn patients with opioid problems also had other mental health problems. This shows how important it is to treat pain and mental health carefully in burn survivors. This study looks at how PTSD affects opioid use in people with burns. It uses data from many hospitals to see if PTSD makes pain worse and makes people use more opioids after surgery. Learning about this can help doctors find better treatments and stop people from using opioids too much if they have PTSD from a burn.