Pain Management
Section editor:
Pain management in wound care is a constant concern for clinicians. Whether ensuring that a patient at the end-of-life or receiving palliative care can rest easily and with dignity or minimizing the pain experienced with a dressing change or a debriding procedure, wound care poses many opportunities for patient-focused pain management.1,2
There are four types of pain associated with wounds:3
Background pain. This is continuous pain stemming from the wound itself.3 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. Offloading devices may help relieve the pain of some wounds by alleviating pressure.
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.3
Procedural pain. Pain experienced during procedures such as dressing changes or pouch changes (wound, fistula or ostomy pouches).3 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 or pouch changes.
Operative pain. Similar to procedural pain, operative pain can be severe enough to require anesthesia for a procedure.3 Wound debridement is an excellent example of a procedure which could 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—including the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Rating Scale—and it is important to maintain the continuity of the scale use throughout a facility to aid in comparisons.4 Pain is also subjective and individual, meaning that pain relief regimens that are highly effective for one patient may not be as helpful for another and procedures that cause one patient a great deal of distress may be less difficult for a second patient. Other factors may affect pain management; for example, a patient near the end of their life might have pain control prioritized over wound healing or other considerations.5
It is vital that health care professionals appropriately address pain that their patients with wounds may experience.2 A full evaluation of the pain, etiology, severity, symptoms, complicating factors, and relevant medical, medication, social, and other history components will help guide the provider to the best intervention for the scenario.
References
1. 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.
2. Shah JB, Krasner DL. Wound Pain Management, Palliative Wound Care and Psychosocial Issues (Chapter 24). In Shah JB, Milne CT (Editors). (2021). Wound Care Certification Study Guide (Third Edition). Best Publishing Company.
3. Bechert K, Abraham SE. Pain management and wound care. J Am Col Certif Wound Spec. 2009;1(2):65-71. Published 2009 May 23. doi:10.1016/j.jcws.2008.12.001
4. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15 Suppl 1(Suppl 1):S17-S24. doi:10.1007/s00586-005-1044-x
5. Woo KY, Krasner DL, Kennedy B, Wardle D, Moir O. Palliative wound care management strategies for palliative patients and their circles of care. Adv Skin Wound Care. 2015; 28(3):130-140.
