Wound pain is complex and patient specific. Pain is shaped by an individual’s emotions and significantly impacts on quality of life. There is no linear relationship between pain and injured tissues.
Healthcare professionals need to appreciate the ‘lived experience’ of pain and empathise with their patient. Involving a patient in pain assessment may resolve anxiety and restore the ‘loss of control’1,2.
Assessment of pain is difficult because it is highly personal. Methods of pain assessment include verbal and visual assessment scales, the most widely used is the Visual Analogue Scale, a linear scale which can run from 1 - 5 where 1 is no pain and 5 is the worst pain imaginable. Scales help patients visualise pain3.
Pain associated with wound care may be as a result of exposed structures in the wound, such as nerve endings or underlying pathophysiology, such as ischaemic vascular pain. Wound infection can lead to pain due to the vasodilatation and increased exudate and pressure on the tissues. Pain also can be attributable to the peri-wound area if it becomes excoriated by wound exudate. Pain is often the result of inadequate assessment, inappropriate wound management strategies, or an insensitive approach to care.
Selection of the correct dressing regime coupled with appropriate levels of analgesia is critical. Traditional dressings and antiseptics can cause trauma and pain and stinging to the wound bed on application / removal and whilst in situ as they are either abrasive or can adhere and dry out sticking to the wound bed4. No sting medical adhesive removers, such as Appeel may be used for fast, painless removal of adhered dressings and as they do not contain alcohol they do not sting vulnerable, fragile and sore skin. The effectiveness of such products has been demonstrated in patients with Epidermolysis Bullosa who have extremely fragile skin.
Modern wound care dressings which facilitate healing but do not adhere to the wound surface and protect the peri-wound area should minimise the pain for the patient. Such dressings include; hydrocolloids, alginates, foams3. Liquid barrier films without alcohol such as LBF are ideal for protecting the peri-wound areas from exudate and dressings which may adhere.
1 Walding, M.F. (1991) Pain, anxiety and powerlessness. Journal of Advanced Nursing: 16, 388 - 397
2 Seers, K. (1989) Patients perceptions of acute pain. In Wilson-Barnett, J. and Robinson, S. (Eds.) (1989) Directions in Nursing Research, Harrow, Scutari Press. Chapter 12, pg 107 – 116
3 Hollinworth, H., Collier, M. (2000) Nurse’s views about pain and trauma at dressing changes: results of a national survey. Journal of Wound Care: 9; 8.
4 Thomas, S. (1990) Wound management and dressings, London, The Pharmaceutical Press.
Caveat: The information given is a guide only and should not replace clinical judgement.