Cath Lab Digest

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  The pain experience is an unpleasant sensory and emotional response to injury - only the person enduring the sensation can provide an accurate description. We have learned from the field of psychoimmunology that emotions strongly influence the body's response to illness, infection, and recovery. Only recently has the healthcare community begun to connect the dots between wound trauma, pain, emotions, and delayed wound healing. The outcome? Pain doesn't have to be a part of wound care.

The Emotional Experience of Pain

  The most common components of local chronic wound care are wound cleansing, dressing changes, and debridement. Because most patients with wounds have experienced pain, they often harbor feelings of fear and anger, believing that all such procedures have to be painful and feeling skeptical about future wound treatments and the clinicians providing care. As a result, patients often do not report wound pain verbally or cognitively; instead, they communicate pain through behaviors. Expression of pain may include body language, signs of anxiety and depression, lack of compliance with therapy, and missed appointments. Depression is a common component of patients with chronic health conditions, including chronic pain and chronic wounds. Rebuilding trust is extremely difficult because of the negative expectations of patient and clinician. If problems of depression and anxiety persist and the clinician seems unable to help the patient recuperate, referring the patient for psychiatric help is appropriate.

  In addition, social and cultural factors such as religion, the meaning of pain, and the desire to be a "good patient" all are contributing factors for patients and caregivers underreporting pain. Myths abound regarding the negative side effects and addictive tendency of pain medications. Thus, many individuals just believe that they are better off to "tough out" wound pain.

Changing the Paradigm

  Pain is a personal matter - only the individual can accurately evaluate and report his/her pain Therefore, the patient must be brought into the process from the beginning. The clinician should:
  * Determine the patient's goal for managing his/her pain
  * Empower the individual by letting him/her know that appropriate pain relief is a right
  * Teach the patient that less pain means more gain in wound healing
  * Assure the patient that he/she will be part of the team effort to develop a pain relief plan and that the plan can change if the pain is not under control.

  The goal is to provide the patient with a sense of personal control over the pain by changing myths and misconceptions through education and noticeable results.

The Pain Control Plan

  Pain assessment. Use a pain assessment tool to develop the pain control plan. A good tool should allow the patient and clinician to determine the location of the pain (with body diagrams to mark), the intensity as rated on a pain scale (including the scale used), the effects of interventions on the pain (worse, better), the quality of the pain in the patient's own words (eg, stabbing, burning, throbbing, itching), onset (what causes pain?), duration, variations, aggravating and relieving factors of pain, previous treatment and results, attitudes towards medications, coping strategies, preferences, and expectations.

  Using a tool such as a numeric pain rating scale (NPRS), visual analog scale (VAS), or faces scale to quantify a patient's pain level has become standard for assessing pain. All three have been validated - a numeric pain scale has been shown to be a more appropriate choice for elderly patients and a faces scale is effective for children and people with cognitive problems. Have the patient select a pain scale that he/she feels best describes the pain.