Cath Lab Digest

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We all must die. But if I can save him from days of torture, that is what I feel is my great and ever privilege. Pain is a more terrible lord of mankind than even death itself. - Albert Schweitzer (1875-1965)

  Pain is a highly individualized experience. Because physicians must depend on their patients' subjective and, therefore, varied responses to the sensation, pain is one of the more difficult symptoms, if not to observe and document, then to quantify. In short, pain is challenging to assess and treat.

  Clinical approach to pain, however, is changing. In its 2001 mandate, "Taking the Ouch Out of Pain,"¹ the Joint Commission of Accreditation of Health Care Organizations (JCAHO) set forth standards for long-term care requiring that pain not be ignored. According to JCAHO, long-term care residents have certain pain-related rights, including but not limited to appropriate pain assessment and documentation, referral for management, and education on management beyond the caregiving facility.

  Pain has become a major factor when considering quality-of-life issues. In some healthcare circles, clinicians accept the reality of wound treatment as opposed to wound healing - that similar to certain conditions and diseases (diabetes, for example), complete healing is not yet possible.² Wound care providers, front-line champions of restoring quality of life in the face of chronic situations, have turned their attention to pain and its impact during treatment. They know that pain must be addressed in wound care.

  To this end, Ostomy/Wound Management, with the support of Mölnlycke Health Care, has created the column "Addressing the Pain" to focus on the pain experience as it relates to wound care. Each month, various clinicians renowned for their progressive wound care ideas and practices will lend their expertise to present theory and practical advice on relieving and removing the pain of wound care. Among the potential topics: pain assessment (eg, methods, tools); pain as it relates to different types of wounds, different types of treatment, and age; traditional pain management (eg, dressings and topical and systemic analgesics); alternative and emerging treatments; and patient education and care beyond the healthcare facility. O/WM and Mölnlycke hope to become a resource for wound pain information, linking readers to a network of vital, ever-evolving pain information.

  One critical piece of information comes from the European Wound Management Association (EWMA). In response to increasing acknowledgment that pain is a factor in many different types of wounds, EWMA developed a position document to provide direction for assessing and managing wound pain. This document is specific to dressing changes in chronic wounds.

  In the course of creating the document, EWMA confirmed the paucity of evidence-based practice and literature available. This was underscored by the diversity in approach to care as determined by a multinational survey of wound care professionals. Such diversity may be due to the variations among healthcare delivery systems, along with inconsistent access to and knowledge of products. Indeed, even the JCAHO document notes that the response to patient pain is based on the services the healthcare facility provides.