Articles Posted in Psychological Consequences of Burns: Long Term Rehabilitation

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In August 2011, Randy McAllister suffered third degree burns while trying to save equipment from a fire in wheat field. Today, he says that when he goes for his burn treatments, “it gets me to the threshold where I can’t stand it, but then I find out it can hurt even more,” says the 60-year-old farmer. During five weeks at the Oregon Burn Center at Legacy Emanuel Medical Center in Portland, Oregon, McAllister needed repeated rounds of burn wound care to remove dead tissue from his extensive burns. “It’s more painful than the fire.”

Then a nurse told him about SnowWorld, a computer game designed to help burn patients escape from agonizing pain by distracting their minds during burn treatments. During his next wound care session, McAllister wore headphones and looked through virtual reality goggles. He found himself floating through an icy canyon rendered almost three-dimensional by the wrap-around goggles. By tapping on a computer mouse, McAllister fired snowballs at animated penguins, snowmen and dolphins in the canyon to a soundtrack of upbeat music. And the virtual world made his real-world pain less overwhelming.

It’s one of the most successful examples of non-drug pain management techniques to emerge from the work of psychologists and neuroscientists. The search for non-drug options has gained urgency amid a worsening epidemic of overdoses linked to prescription opioid pain relievers such as oxycodone and hydrocodone, which killed 14,800 Americans in 2008 – more those killed from heroin and cocaine overdoses combined.

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There is an uplifting story on CNN.com today about a burn victim who is not only is healing physically from his burns, but also psychologically. Here’s the proof: The boy, Youssif, was given a “certificate of citizenship” recently, which is an award for being exceptionally nice to a fellow classmate in school. Another boy got hurt, and Youssif helped the boy with his gashed arm by applying an ice pack and helping to stop the bleeding.

Youssif is proud of his award–and his family, his doctors, and his entire support system should all be proud as well. Four years ago, Youssif suffered third degree burns to his face–much of it melted, actually–during a battle among local sects in Iraq. But after dozens of surgeries in the United States, doctors have been able to reverse a lot of the horrible burn scars. Not only that, but Youssif is no longer the sad, quiet child he was in the few years after his burn injury.

Through extensive counseling with his family, he is now able to cope with the facial scars he still has from the attack, and he also has an upbeat attitude that’s hard to believe. He says his looks no longer bother him, “because none of my other friends make fun of me,” he says in English. His mother is so happy to see her boy like he was before he was burned. “His personality has changed so much,” she told CNN.com. “The way he interacts with people, and everything else. It began as soon as he started school and realized that the children don’t care about his appearance. It allowed him to have a normal life.”

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During this phase the patient is discharged from the hospital and starts to reenter and reintegrate into life and society. Interacting with family members, friends and the rest of the community may be difficult at first. The patient may be used to the hospital environment, leaving the hospital; they will have the fear of being rejected by the community because of their change in appearance or abilities. Other issues that face the patient during this stage are dealing with returning to work, changing their image and resuming sexual activities. Patients may develop anxiety and depression as a result of these issues.

Going through rehabilitation, exercises, dressing changes, pressure garment use, amputations, scarring and itching may all have an effect on the patient emotionally and physically.

Treatment provided in this stage begins before discharge by explaining and preparing the patient and family for the difficulties anticipated after discharge. Outpatient counseling, social skill training and support groups play a role in recovery. Family and friends’ support and the patient’s willingness to engage himself/ herself in society play an important role in recovery.