Wound Pain

DR. SAMARA SHAUKAT

 INTRODUCTION

Pain is an unpleasant sensory and emotional experience

associated with actual or potential tissue damage, or
described in terms of such damage.
 Patient’s concerns

Patients view pain as the worst aspect of their chronic wound.

‡They rank pain control as more important than healing.
‡Pain has been shown to be a primary reason for why they fail to attend
clinic visits.
 Types of Pain
Nociceptive
Response to a painful stimulus which may involve acute or chronic
inflammation (tissue injury)
„ Examples:
somatic and visceral pain, such as a pressure ulcer
„ Quality:
aching, throbbing cramping and well-localized
Neuropathic
Inappropriate response caused by dysfunction in the nervous system.
Stimuli abnormally processed by the nervous system (nerve injury)
„ Examples:
shingles pain and diabetic ulcer
„ Quality:
burning, stabbing or electrical
 Acute vs. Persistent
Persistent Pain
„ Avoid term “chronic”
„ Can be from a cancerous or non-cancerous source
„ Pain that has lasted 3 months or longer Usually associated
with functional and psychological impairment
„ Has not responded to current available treatment methods
„ May continue for the remainder of the patient’s life
„ Examples: arthritis, back pain, fibromyalgia and some ulcers
 Acute vs. Persistent

Acute Pain
„ Distinct onset
„ Obvious cause
„ Short duration
„ Subsides as healing takes place
Recurring or an exacerbation
„ Can occur periodically over an extended period, postoperative pain
„ Examples: burns, laceration, dressing change, bee sting and an
example of a c u t e p a i n i n c h r o n i c s i t u a t i o n , s i c k l e c e l l
crisis
 Procedural Pain

„ Biopsy 3. ‡morphine
„ wound and burn debridement 4. ‡hydromorphone (Dilaudid)
„ incision and drainage „ General anesthetics
„ dressing change for analgesia and sedation
‡Pharmacologic approaches 1. ‡nitrous oxide or propofol
local anesthetics (Diprovan)
1. ‡injectable lidocaine and 2. ‡benzodiazepines like Versed
topical EMLA cream and Valium
2. „ systemic opioid analgesics
 Nonprocedural Pain

Pain resulting from conditions or syndromes

„ Cancer
„ HIV
„ Trauma
„ Infection
„ Inflammation
„ Diabetes
„ Chronic disease
 Pain Assessment
Palliative/proactive factors
„ What makes the pain worse? > Aggravating Factors
„ What makes it better? > Relieving Factors

‡Quality of pain
„ What kind of pain are you experiencing?
„ How would you describe it, sore, burning, etc.?

‡Region and Radiation of pain

„ Where is the pain? Does it radiate?

Severity of pain
„ Can you rate your pain on a scale of 1 to 10?

‡Temporal aspects of pain

„ When does it stop and start?
 GOAL

The patient’s pain experience is assessed and managed

effectively to the patient’s satisfaction.
 The Chronic Wound Pain
Experience Model
Acute cyclic
„Dressing changes

Acute non-cyclic
„Debridement or drain removal

Chronic
„Persistent pain in the absence of manipulation
 Wound Care Goals
What end-point do you expect?
„ Closure
„ Wound stabilization
„ Improvement
„ Palliative care
‡Decrease pain and odor
‡ Identify on admission
‡ Consistent with overall objectives and priorities
‡ Does symptom management outweigh a curative treatment
plan?
 Patients most at risk for under treatment of pain

Elderly
‡Infants and children
‡Cognitively impaired
L‡anguage or communication barrier