Practical Treatment of Wound Pain and Trauma: A Patient-Centered Approach. An Overview

Author(s): 
Madhuri Reddy, MD, FRCPC(Geriatric Med); Rosemary Kohr, RN, MScN, ACNP; Douglas Queen, BSc, PhD, MBA; David Keast, MD, FCFP; and R. Gary Sibbald, MD, FRCPC(Med)(Derm)

Other dressing-related factors that can cause pain include the dressing absorbency mechanism; dressing adherence; friction between dressing surface and wound bed; dressing/granulation tissue integration; and the presence of allergens.
Moisture balance (dressing performance). The way a dressing absorbs and manages exudate not only affects the physical performance of the material but also impacts wound pain. A dressing will adhere to the wound if it absorbs too aggressively or if the primary dressing allows strikethrough, adhering to secondary layers or regimens. Adhesion of primary and secondary products can result in the accidental traumatic removal of the primary contact layer and cause damage (and pain) to the wound bed.
Fibrous products (eg, alginates and hydrofibers) are excellent primary contact layers. They are gel-formers; as a result, they bathe the wound bed in a soft soothing gel. This allows nontraumatic removal and generally provides pain relief.
Some dressings are abrasive and can cause friction or adherence to the wound surface (eg, some gauze-based products). This can be avoided by using appropriate dressings (eg, gels/foams) or utilizing a nontraumatic wound contact layer (eg, soft silicone dressings). Research has shown these products to be relatively atraumatic upon removal.57
Adhesive dressings, as the name suggests, can be traumatic to both the wound bed and the periwound area. Films and hydrocolloids should be removed with care as recommended by the manufacturer's instructions.
Hydrocolloids are generally nonadherent to the wound bed because they form a soft, conforming gel in the presence of exudate.58 Care should be taken upon removal, however, to ensure no skin stripping of the periwound area.59 Again, appropriate use will prevent damage and pain and provide an effective moist wound environment.60
Care also should be exercised regarding the choice of dressing or other topical treatment regarding allergens that can cause uncomfortable or painful inflammation (ie, allergic response). Use of products with a high sensitization potential (eg, neomycin, Bacitracin, lanolin, and perfumes) in patients with leg ulcers should be avoided.61
Wound pain as a result of inappropriate local wound care generally can be corrected. A well-devised local wound care regimen with the appropriate elements (dressings for moisture balance, bacterial balance/controlled inflammation, and autolytic debridement where appropriate should be patient, wound, and disease specific (see Table 7).

Conclusion
Pain is often neglected because no simple diagnostic test exists to measure it. Quite simply, "Pain is what the patient says it is." Too often clinicians ignore pain because it is not easy to measure, yet unrelieved pain may seriously hamper efforts to heal chronic wounds. A paradigm that integrates pain management into an approach to wound bed management provides the clinician with a framework for improved care. An approach to chronic wound pain management that treats the cause and addresses local wound factors may lead to improved outcomes as patients may be more adherent to optimal care plans. A patient-centered regimen ensures appropriate care in a reduced pain environment (see Table 8). - OWM

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