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Wound Pain
Wounds of any etiology may be very painful. Proper pain assessment will help determine the cause of pain and indicate strategies for relief.
Practical Treatment of Wound Pain and Trauma: A Patient-Centered Approach. An Overview
Chronic wound pain is distressing and influences the patient's ability to function. One of the failures of modern medicine is the inadequate assessment and treatment of pain. The clinician's approach to chronic wound pain combines the "preparing the wound bed" paradigm with chronic wound pain models. A holistic approach must include the diagnosis and treatment of the underlying cause, identification and correction of patient-centered concerns, and the three major components of local wound care (debridement, bacterial balance/prolonged inflammation, and moisture balance). The Krasner pain model defines chronic (persistent), noncyclic acute, and cyclic acute wound pain. Chronic persistent wound pain without an event or trigger often relates to the cause of the wound that needs to be corrected to relieve the pain. Noncyclic acute pain is often experienced with a surgical procedure such as sharp debridement. Cyclical acute pain may occur repeatedly with removal or application of new local wound dressings. Securing a thorough pain history focusing on pain patterns will help healthcare professionals develop specific pain relief initiatives. Pain is a component of quality of life. Patient-centered concerns need to address pain control measures until the cause of the pain can be corrected. Controlling pain, however, may not always improve quality of life scores. Each of the components of local wound care also may be responsible for the production of pain; strategies need to be implemented to ensure adequate patient comfort.
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Pain in Fungating Wounds: Another Perspective
This article is adapted from Naylor W. Assessment and management of pain in fungating wounds. British Journal of Nursing. 2001;(suppl);10(22)
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Understanding the Origin of Wound Pain during Dressing Change
The following is excerpted from Briggs M, Torra i Bou JE. Pain at wound dressing changes: a guide to management. European Wound Management Association Position Document. Pain at wound dressing changes. London, UK: Medical Education Partnership LTD; 2002.Used with permission.
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Managing Wound Pain in Patients with Vacuum-Assisted Closure Devices
The etiology and management of wound pain for patients with vacuum-assisted closure devices can be complex. Patients, such as the patient with necrotizing fasciitis described in this case study, may experience all three types of pain described in the Chronic Wound Pain Experience Model ? acute noncyclic, acute cyclic, and chronic. Strategies that include local wound management to reduce all three types of pain and holistic psychological care to reduce the ache and anguish that may accompany dressing change procedures may help provide comfort and reduce pain and suffering.
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Pain from Skin and Wound Conditions: Part 2
Pain from Skin and Wound Conditions: Part 2 Skin Matters: Pain from Skin and Wound Conditions: Part 2 - Diane L. Krasner, PhD, RN, CWCN, CWS, BCLNC, FAAN Part 1 of this article provided a general approach to skin and wound pain and included a guide to managing painful skin and wound conditions. Conceptual models are developed to help guide clinical practice and critical thinking. &...
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The Effect of Noncontact, Low-Intensity, Low-Frequency Therapeutic Ultrasound on Lower-Extremity Chronic Wound Pain: A Retrospective Chart Review
Pain associated with chronic wounds and related wound care modalities presents a persistent clinical challenge in patient care, yet evidence supporting the effects of interventions on wound pain remains sparse. In response to initial clinical observations that several patients with painful chronic lower-extremity wounds reported a reduction in wound pain shortly after ultrasound therapy was initiated, a retrospective chart review and analysis of reported pain scores was conducted. The records of 15 consecutive patients (eight women, seven men, age range 28 to 88 years) with painful, nonhealing, lower-extremity wounds treated for 2 to 4 weeks with noncontact, low-intensity, low-frequency therapeutic ultrasound were reviewed and recorded pain scores abstracted. Mean pain scores decreased from 8.07 (± 1.91) pre-treatment to 1.67 (± 1.76) post-treatment (P = 0.0003). No patients reported worsening pain after treatment commenced. This preliminary evidence suggests that prospective, controlled clinical studies to evaluate the effect of this treatment on wound-related pain are warranted. KEYWORDS: ultrasound, pain, wound modalities, lower-extremity wounds, debridement
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Introduction
An expert panel has combined current knowledge in wound pain with the "preparing the wound bed" paradigm. After studying these modules, the reader will be able to: * Develop an approach to treating the cause of wound pain and patient-centered concerns * Analyze the components potentially responsible for local wound pain: debridement, bacterial balance, and moisture ...
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Plain Talk about Wound Pain
Neuropathic pain is a form of chronic pain. The Chronic Wound Pain Experience According to Krasner? Treating the Patient with Pain When persistent pain is experienced, long-acting drugs are preferable.
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Pain in Acute and Chronic Wounds: A Descriptive Study
The significance of pain in wound healing is much neglected because of biases against pain management in general, a lack of knowledge of available analgesics, and difficulties associated with pain measurement. To assess pain in patients suffering from acute and chronic wounds, a 1-day descriptive study was conducted involving 50 patients ? 26 with acute wounds and 24 with chronic wounds ? served by the wound clinic of a university hospital. Patients responded to questions regarding onset, location, type, and intensity of pain using the Visual Analog and Visual Reporting Scales and to statements about aggravating and relieving factors and overall impact on their quality of life using a 5-point scale where 5 = totally agree and 1 = completely disagree. Results showed pain was commonly mild to moderate (41 patients, 88%), located in and around wound (43 patients, 93.5%), occurred most frequently during dressing change (30 patients, 65%), and was relieved by medications (39 patients, 84.8%) and positioning (17 patients, 37%). The most commonly affected quality of life variables were physical activity (40 patients, 87% of patients) and social functioning (23 patients, 50%). Controlling wound pain can play a major role in improving patient quality of life. KEYWORDS: Descriptive study, wounds, pain, quality of life
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A Prospective, Open-Label Study to Assess the Clinical Performance of a Foam Dressing in the Management of Chronic Wounds
Polyurethane foam dressings are used to help absorb wound exudate while maintaining a moist wound environment. To assess the clinical performance of a foam dressing, a prospective, open-label evaluation of 57 outpatients (mean age 69 years) with delayed/non-healing wounds (one per patient, average duration 1.4 ± 4.1 years) of different etiologies was conducted in 15 medical centers in Germany. Physicians assessed the clinical appearance of the wound bed, periwound skin, and exudate level at the beginning and final evaluation and dressing performance characteristics were rated. Patients were asked to assess their wound pain as none, mild, moderate, or strong. After three dressing changes (performed approximately 3 days apart), slough and necrotic tissue on the wound surface changed from an average of 54% (± 33%) to 29% (± 25%). At baseline, granulation tissue covered an average of 41% (± 31%) of the wound bed compared to 59% (± 24%) at the final assessment and the proportion of wounds assessed as heavily exudating decreased from 32% to 11%. During the evaluation, the proportion of patients without periwound skin problems increased from 49% to 66% and the percentage of patients with wound pain decreased from 45% to 26%. Between 80% and 90% of the participating physicians rated the product attributes assessed as ?very good? or ?good.?
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