Journal of Community Nursing - page 36

36 JCN
2013,Vol 27, No 4
ain has always been a major
issue during dressing changes
in patients with both acute
and chronic wounds. Patients
describe wound-related pain as
all-encompassing and one of the
most devastating aspects of living
with a chronic wound (Price et
al, 2008). The European Wound
Management Association (EWMA)
position document,
Pain at Wound
Dressing Changes
(Moffat et al, 2002)
identified dressing removal as the
time of greatest perceived pain. This
is supported by Price et al (2008) who
stated that pain is more intense at
dressing change and can take up to
two hours before it begins to subside.
Therefore, Soon and Acton (2006)
have suggested that minimising
trauma and pain should be a
key objective for all healthcare
professionals involved in the care
of patients with wounds. Bell
and McCarthy (2010) agree that
healthcare professionals should have
sufficient knowledge of evidence-
based pain assessment and dressing
selection to minimise any wound
pain while changing dressings.
Dealing with wound-related pain at
dressing change
However, despite this, Moffatt et
al (2002) have stated that healthcare
professionals are often reluctant to
acknowledge the amount of pain
endured by patients. Dallam et al
(2005) support this, highlighting that
wound- and dressing-related pain is
underestimated and poorly managed,
which may lead to extended healing
times. Similarly, other researchers
have noted that pain management
at dressing changes is still an issue
(Reddy et al, 2003); that there is
a degree of complacency from
healthcare professionals when
managing pain (Hollingworth, 2007);
and even that the management of
pain by healthcare professionals
is often seen as a low priority
(Vermeulen et al, 2007).
To combat this, the International
Association for the Study of Pain
(IASP, 2004) have recommended
that healthcare professionals should
understand the mechanisms of pain,
types of pain, and any influencing
factors on the patient’s perception of
pain, as well as possessing the ability
to assess pain and alleviate it.
Pain is an unpleasant sensory and
emotional experience associated with
actual and potential tissue damage.
It is highly individual and patients’
mental state, environment and
cultural background can all have an
influence on their perception of pain
(Soon and Acton, 2006).
Pain can contribute to stress
and other negative states including
fear, anxiety and depression, all of
which may complicate the healing
process (Woo et al, 2008), while
Shukla et al (2005) stated that pain
can frighten and disable more people
than many diseases. Solowiej and
Upton (2012) contended that as pain
is a biopsychosocial phenomenon,
psychological and social factors, as
well as physical aspects, need to
be taken into account if it is to be
successfully managed.
Upton (2011) added that there
are a number of emotional issues
that can influence the experience of
pain — the extent of the injury, its
management, anxiety and depression
can all increase the experience of
pain. Woo et al (2008) added that
increased levels of stress and anxiety
have been demonstrated to lower pain
thresholds and tolerance. Therefore,
there is often a cycle of pain, stress and
anxiety, which worsens the patient’s
experience of pain. Richardson and
Upton (2011) stated that stress may
disappear if pain is well-managed and,
if the stress is reduced, the pain cycle
can be broken.
Vuolo (2009) suggested that
wound-related pain can vary in
intensity, but that it can impact on
wound healing (Pediani, 2001; Clay
and Chen, 2005) and quality of life
(King, 2003). Dressing changes
interfere with daily routines, causing
problems with sleep disruption,
mobility, odour and psychological
stress (Soloweij et al, 2009). This is
Jacky Edwards, Burns Nurse Consultant, Burn
Centre, University Hospital of South Manchester
and Lead Nurse, Northern Burn Care Network
Numerous studies have shown that pain during dressing change is a
major issue for patients with both acute and chronic wounds. Despite
this evidence, pain is often misunderstood by clinicians and can be
poorly managed. Pain can result in patients abandoning dressing
regimens and clinicians need to ensure that patients have their pain
reduced as much as possible and do not have to face the trauma of
repeated painful dressing changes. This article presents some of the
causes of pain and outlines some strategies that clinicians can use to
prevent or minimise their patients’ pain.
Wound pain
Dressing change
Atraumatic dressings
Jacky Edwards
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