W ound-related pain is an important component of patient-centered concerns that is often undervalued by healthcare professionals.
In the late 1990s, the European Wound Management Association (EWMA) led the way to changing this attitude with its pivotal position document focused on wound pain. The document recognized and focused on the distress of chronic wound pain and its influence on patients' health-related quality of life. It stated that one of the failures of modern medicine is the inadequate assessment and treatment of pain.The first of its kind, the document helped initiate the sharing of information and best practice throughout Europe. It was translated into French, German, Italian, and Spanish; thus, allowing true European dissemination. As data were compiled, it was hoped that the document would stimulate international discussion.
In North America, therefore, the approach to chronic wound pain must include the diagnosis and treatment of the underlying cause as well as address patient-centered concerns. As such, this educational supplement is presented with a specific wound pain focus, taking the lead from European colleagues.
An expert panel has combined current knowledge in wound pain with the "preparing the wound bed" paradigm. Each module will discuss a common wound type (venous leg ulcers, diabetic foot ulcers, and pressure ulcers) and the implications for pain management.
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 balance
* Explore enablers for practice to help reinforce a patient-centered treatment approach.
The management of wound pain can be integrated into the wound management paradigm originally discussed in Sibbald et al (Preparing the wound bed. Ostomy/Wound Management. 2000;46[11]:14-35): treat the cause, local wound care, and patient-centered concerns. Treating the cause involves the correct diagnosis of the wound pain. The Krasner model assists healthcare practitioners assess pain etiology, and a pain diary helps determine patterns of pain frequency, duration, and intensity. Local wound care needs to revolve around the three pillars of practice: debridement, bacterial balance, and moist interactive healing. Wound dressing plays a significant role in local wound care by supporting normally occurring wound healing processes and enhancing management of the inflammatory response. Patient-centered concerns must focus on what the patient sees as the primary reasons and resolutions for the pain. Anticipatory pain and the suffering that the patient experiences can be just as disruptive to quality of life as the actual pain sensation. - OWM