By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Dressing changes can be painful experiences for clients. Pain is often not addressed or may be addressed inadequately. Pain is a significant issue for many clients and can present a challenge to the treating practitioner.

Types of Pain
There are four types of pain highlighted in the World Union of Wound Healing Societies' consensus document (2004):

1. Background pain- persistent pain due to wound factors (such as infection) and wound etiology
2. Incident pain- caused by activities related to movement, such as friction or dressing slippage
3. Procedural pain- occurs during routine procedures such as dressing changes
4. Operative pain- associated with procedures/interventions that require an anesthetic to manage pain, such as wound debridement

When and How Should Pain be Assessed?
Pain should be assessed at the first visit with a client requiring ongoing dressing changes. The nature (i.e., procedural or incident pain), the location and the intensity of the pain should be documented. Thereafter, pain should be assessed before, during and after a dressing change has been performed in order to determine whether the pain has changed (improved or worsened) and whether the pain relief modalities are still effective in reducing the client’s level of pain.

Use of Pain Assessment Tools
Pain assessment tools are useful because they draw attention to the client’s pain, which may otherwise not be addressed, allow clinicians to recognize changes in pain levels over time, even when different clinicians are seeing the client, and provide a way to clearly measure (quantify) the client’s pain.

Verbal, visual analogue and numerical rating scales are all acceptable tools to measure pain. What is most important is continuity- the same scale should be used for every visit. Together, the client and clinician should decide on an acceptable level of pain for the client. If pain increases, the clinician should make every effort to determine the reason, such as infection, and work to reduce the client’s level of pain to the agreed-upon acceptable level of pain.

Managing Wound Pain During Dressing Changes
Strategies to reduce the client’s level of pain during dressing changes may include:

• Choose the correct dressing- choose a dressing that won’t adhere to the wound bed and can be easily removed. Gauze is most likely to cause pain, while soft silicones, alginates and hydrofiber dressings are less adherent and easier to remove. Choose a dressing that can stay in place longer if pain is an issue and choose a dressing that promotes moist wound healing. Use dressing securement techniques that ensure longer wear-time of the dressing, selecting products that are gentle to skin for removal. If the dressing you have chosen adheres to the wound, consider using a different dressing at the next dressing change.
• Take your time when removing old dressings- remove old dressings and securements slowly so as not to cause trauma to the wound bed. If the dressing has adhered to the wound, take the time to soak the old dressing until it can be easily removed without damaging the wound bed or periwound tissue. Use of
• Use skin barriers- the use of skin barrier products, combined with appropriate dressings and securement products, can reduce trauma to the periwound tissue and can prolong the wear-time of the dressing chosen.
• Encourage analgesics prior to dressing changes- use of NSAIDS or other analgesics prior to a dressing change can significantly reduce pain associated with dressing changes. Be sure to have the client take the medication long enough before the dressing change for the analgesic to take effect. Opioids may be required for moderate to severe pain; these may be dosed around the clock for continuous pain. Consult the client’s physician if pain is not being managed adequately with the client’s current pain medication regimen.
• Allow the client to participate- allowing the client to participate in decisions regarding pain management may help the client to gain a sense of control over their pain. Clients may even choose to remove their own dressing.
• Schedule dressing changes when the patient is feeling well- if possible, allow the client some choice as to when/what time of day the dressing change will take place.
• Consider the use of alternative therapies- consider using visualization, distraction, relaxation exercises and imagery to help reduce stress during dressing changes.

These are just a few of the strategies that can be used to reduce pain during dressing changes. Remember that pain is highly individual; what works for one client may not work well for another. Allowing the client to participate as much as they are able in decision-making can reduce apprehension and pain during the dressing change process.

Sources
Reducing Pain During Wound Dressing Changes. Wound Essentials. Volume 3, 2008. Available at: http://www.wounds-uk.com/pdf/content_9433.pdf.

World Union of Wound Healing Societies (2004). Principles of Best Practice: Minimising Pain at Wound Dressing–Related Procedures. A Consensus Document. Available at: http://www.wuwhs.org/pdf/consensus_eng.pdf.

Sardina, D. (2012). Ouch! That hurts! Wound Care Advisor, October 9, 2012. Available at: http://woundcareadvisor.com/best-practices-vol1-no3/.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.