Pain Management
Section editor:
Pain management in wound care is a constant concern for clinicians. Whether ensuring that a palliative patient can rest easily and with dignity or minimizing the pain experienced with a dressing change or even a debriding procedure, wound care is fraught with pain and thus, opportunities for pain management.
The World Union of Wound Healing Societies differentiates between four types of pain associated with wounds:
Background Pain
This is continuous pain stemming from the wound itself. This includes pain associated with an infection. Pain levels may fluctuate for background pain over the course of the day due to changes in the wound or whether or not the patient is able to distract themselves. Offloading devices can help relieve the pain of some wounds and keep them from deteriorating.
Incident Pain
This is pain caused by movement of some kind whether from friction and shear when the patient moves or the movement of a dressing with inadequate adhesive.
Procedural Pain
Pain experienced during procedures such as dressing changes or ostomy pouch changes. This can sometimes be handled with pre-medication. Moistening dressings before removal, minimizing adhesive use and working slowly with intervals to allow the patient to recover are all strategies to minimize distress for patients undergoing dressing changes.
Operative Pain
Similar to procedural pain, operative pain is severe enough to require anesthesia for a procedure. Wound debridement is an excellent example of a procedure which would produce operative pain.
Pain Management Options in Wound Care
Pain should be assessed frequently to help the clinician ascertain the efficacy of any pain relief modalities as well as the effect any procedures may be having on pain levels. Any number of rating scales for pain are available and it is important to maintain continuity for scale use throughout a facility to aid in comparisons. Pain is also subjective and individual meaning that pain relief regimens which are highly effective for one patient may not be as helpful for another and procedures which cause one patient a great deal of distress may be less difficult for a second patient. Other factors may effect pain management, for example, a patient near the end of their life might have pain control prioritized over wound healing or other considerations.
Note: Pain is whatever the individual says it is and needs to be addressed accordingly by the health care professional.
References
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Krasner DL. The Chronic Wound Pain Experience: A Conceptual Model. Ostomy/Wound Management, April 1995.
Krasner DL. Managing chronic wound pain. 2015 PowerPoint Presentation. Downloadable at www.dianelkrasner.com/Resources.
Sardina D. "Ouch! That hurts!". Wound Care Advisor. 2012. Available at: http://woundcareadvisor.com/best-practices-vol1-no3/. Accessed November 15, 2018.
Suzuki K. A guide to pain management in wound care. Podiatry Today. 2012; 25(11): 22-24.
Swezey L. How to Decrease Pain Associated with Wound Dressing Changes. WoundSource. 2013. http://www.woundsource.com/blog/how-decrease-pain-associated-wound-dress.... Accessed November 15, 2018.
Tippett A. Treat the Patient, Not the Wound. WoundSource. 2011. https://www.woundsource.com/blog/treat-patient-not-wound. Accessed November 15, 2018.
Woo KY, Krasner DL, Kennedy B, Wardle D, Moir O. Palliative wound care management strategies for palliative patients and their circles of care. Advances in Skin & Wound Care. 2015; 28(3):130-140.
Woo KY, Krasner DL, Sibbald RG. Pain in People with Chronic Wounds: Clinical Strategies for Decreasing Pain and Improving Quality of Life (Chapter 9). In Krasner DL, van Rijswijk L, eds. Chronic Wound Care: The Essentials e-Book. Malvern, PA: HMP; 2018:111-122. Downloadable at www.whywoundcare.com/Resources.
Woo KY, Sibbald RG. Chronic Wound Pain: A Conceptual Model. Advances in Skin and Wound Care, 21(4):175-188. May 2008.
Woo KY. Meeting the challenges of wound-associated pain: anticipatory pain, anxiety, stress and wound healing. Ostomy/Wound Management 54(9):10-2, 2008.
World Union of Wound Healing Societies. Principles of Best Practice: Minimising Pain at Wound Dressing–Related Procedures. A Consensus Document. 2004
