Painful Wounds- Assessment and Intervention
Wounds often cause pain, and untreated may may lead to decreased adherence with wound care. For this reason, it is important to assess patients for the presence of pain and ask what the patient is doing to relieve pain. If pain is inadequately treated, the wound care clinician should intervene to relieve pain to the greatest extent possible.
Causes of Wound Pain
The following may contribute to wound pain:
- Ambulation- patients with wounds caused by arterial insufficiency may suffer from pain due to tissue ischemia. Ambulation may worsen or initiate this type of pain because exercise increases tissue metabolism.
- Elevation- patients with arterial insufficiency wounds may also complain of pain when their affected leg is raised, as this position further compromises tissue perfusion.
- Dependency- patients with wounds caused by venous insufficiency often experience pain when their affected extremity is in a dependent position, as venous insufficiency causes venous hypertension and edema of the affected limb.
- Infection- infected wounds are often painful wounds due to an increased inflammatory response. Infection may be suspected in wounds that are red, swollen and draining purulent material. Increased pain is often a sign that a wound is infected.
- Neuropathy- damage to nerves may cause pain in the affected extremity (on the other hand, neuropathy may lead to the inability to feel pain at all).
Assessment of Wound Pain
To start, the following questions can be asked:
- Where exactly is the pain located? Is it localized to one spot or generalized to a larger area?
- What is the nature of the pain? What words would you use to describe the pain (i.e. sharp, dull, aching, burning)?
- Does the pain come and go, or is it constant?
- What makes the pain worse? What makes it better?
- What non-pharmalogical methods of pain relief have you tried? Did it help?
- Are you taking any pain medications? If so, what is it and how often are you taking it?
- How would you rate your pain in terms of severity?
For this last question, there are several pain rating scales that can be used to rate pain. A numerical scale rates pain on a scale of 0 to 10 (or 0 to 5), with zero representing the absence of pain and the highest number typically representing the worst pain imaginable. Verbal pain rating scales or the Wong-Baker FACES rating scale may be more suitable for patients who are illiterate or for children (the Wong-Baker scale).
Managing Wound Pain
Once all of the necessary information has been gathered, it’s time to intervene. Suggestions for pain relief are based upon knowledge of the type of wound and the patient’s history and preference.
For example, for arterial insufficiency wounds, education regarding activities that are likely to exacerbate the pain (ambulation and elevation) will lead to the suggestion to avoid these activities. Pain caused by edema and venous hypertension related to venous insufficiency may be relieved by compression and leg elevation. Relaxation exercises may be helpful for some patients who are open to the idea.
Patients with moderate to severe pain not relieved by over-the-counter analgesics may require a referral back to their physician for a prescription for a more potent oral pain medication. Patients with moderate to severe pain should be counselled to take pain medication prior to dressing changes to decrease pain caused by the procedure. Regardless of the intervention, it should be tailored to the needs of the patient and reevaluated for efficacy at every appointment.
Wound care clinicians can make a huge difference in quality of life for patients suffering from wound pain. Relief of wound pain requires astute assessment of the wound. Pain management should be holistic and should be tailored to the patient’s condition and preferences.
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Meyers, B. (2008). Wound Management: Principles and Practice. 2nd edition. Pearson Prentice Hall. Upper Saddle River, New Jersey.
Mudge, E & Orsted, H. (2010). Wound infection and pain management made easy. Wounds International, vol 1 issue 3 http://www.woundsinternational.com/made-easys/wound-infection-and-pain-management-made-easy/page-1