Wound Pain Assessment

The Wounded Man

A wood cut – early trauma-medicine. first appearing in
Johannes de Ketham’s Fasciculus Medicinae, 1492.

 

 A battle map of the human body, showing the effects of what happened to that body when someone tried to erase its existence. It was accompanied by instructions on how to deal with all of the trauma, and to save the man thus that he could fight again. 

 

Wound Pain Assessment

• wound pain impacts QoL and functioning
• Pain or change in pain can be indicative of inflammation or infection

Note in Every Assessment:

1. Location
2. Frequency
3. Onset
4. Duration
5. Intensity (Pain Scale)
6. Exacerbating or relieving factors

Wound Pain can be divided into 3 categories

1. Non-cyclic acute wound pain

• occurs during manipulation of the wound (eg. Wound debridement)
• local anesthetics can provide some relief

 2. Cyclic acute wound pain

• accompanies regular procedures (dressing changes and repositioning)
• non traumatic dressings, soaking dressing prior to removal and allowing pt to control procedures are pain minimization strategies.

 3. Chronic wound pain

• persistently felt, even when wound is not being manipulated
• medications can help control pain

Studies have shown:

“Trauma during dressing changes was again recognised to be caused by adherent products and drying out of dressings. Although gauze has a major traumatic effect during removal (Grocott, 2000), practitioners did not consider this cause of tissue trauma as an important issue. Perhaps this is because, contrary to best practice, some countries still advocate the use of wet to dry gauze dressings for debridement;

– The most common strategies to manage pain at dressing changes were to soak old dressings, choose non-traumatising dressings and select dressings that do not cause pain during removal. However, soaking dry dressings is contrary to recommendations and may compromise the current principles of moist wound healing (Hollinworth and Collier, 2000). In addition, involving patients in strategies to avoid pain and supporting the surrounding skin during removal were not considered important, despite evidence that adhesive wound care products lead to skin stripping and potential pain and skin trauma (Gotschall et al, 1998; Dykes et al, 2001);

– Only respondents from the UK and France considered giving analgesia before dressing change as an important factor. Respondents from Spain, Austria and Germany only ranked this as their last but one option, even though the prolonged inflammatory response in chronic wounds can lead to increased sensitivity in the wound and surrounding skin (Briggs and Torra i Bou, 2002);

 While research over the past decade has concentrated on wound healing and how this can be improved using evidence-based practice, studies repeatedly demonstrate that the pain of chronic wounds has a major impact on patients’ quality of life (Charles, 1995; Franks and Moffatt, 1998). In addition, wound pain and tissue trauma – especially at wound dressing changes – has been marginalised as an issue by health care professionals (Hollinworth, 1999).”

Hollinworth, Helen. 2002. How to alleviate pain at wound dressing changes. Nursing Times. 98 (44) 51.

Perry, A, G, Potter, P, A, Ross-Kerr, J, C and Wood, M, J. 2006. Canadian fundamentals of nursing. 3^rded. Toronto: Elselvier