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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.


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