Wound pain can be classified in two ways; according to the pattern of occurrence or according to the origin. Both classifications are necessary to completely characterize the pain caused by an individual wound.
The classification of pain by occurrence was formalized by Krasner, who devised the following three categories: Noncyclic acute wound pain, Cyclic acute wound pain, and Chronic wound pain.
Three Categories of Pain Classification
- Noncyclic acute wound pain occurs in single or infrequent episodes, typically during an intervention such as debridement
- Cyclic acute wound pain accompanies repetitive procedures such as dressing changes or changes in patient position and therefore occurs more regularly
- Chronic wound pain is persistent and occurs without external stimulation
Origin of Wound Pain
The origin of wound pain is usually described either as nociceptive or neuropathic. Nociceptive pain occurs in response to tissue damage and usually resolves once the damage is repaired. Nociceptive pain is typically described as throbbing or aching, and the severity of pain usually correlates with the level of tissue damage. By contrast, neuropathic pain results from an injury to the nerve tissues or fibers themselves and is usually independent of acute stimuli or injury. Neuropathic pain may be experienced as a tingling or stinging sensation in mild cases, escalating to a stabbing or burning pain in more severe cases.
Cyclic or noncyclic acute wound pain usually results from actual tissue damage and is therefore generally nociceptive in origin. By contrast, chronic pain is often more complex, usually with a mixed nociceptive/neuropathic origin.
Pain Intervention & Pain Management
The classification of pain according to the origin is important because nociceptive and neuropathic pain responds to different pharmacological interventions. For example, nociceptive pain often improves under treatment with opioids, while neuropathic pain is generally more difficult to resolve and usually requires the addition of adjuvant therapies such as antidepressants or anticonvulsants.
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