Special reports Case reports PAIN PRINCIPLES


1 - Identify and treat the cause of the chronic wound and address concerns expressed by the patient, including a pain assessment at each visit


2 - Evaluate and document pain intensity and characteristics on a regular basis (before, during and after dressing-related procedures) 3 - Cleanse wound gently — avoid the use of abrasive wipes and cold solutions


4 - Select an appropriate method of wound debridement and include the potential for causing wound-related pain


5 - Choose dressings that minimise trauma/pain during application and removal 6a - Treat infections that may cause wound-related pain and inhibit healing 6b - Treat local factors (eg inflammation, trauma, pressure, maceration)


7 - Select an appropriate dressing to minimise wound-related pain based on wear time, moisture balance, healing potential and periwound maceration


8 - Evaluate each patient’s need for pharmacological (topical/systemic agents) and non-pharmacological strategies to minimise wound-related pain


9 - Involve and empower patients to optimise pain management 10 - Healthcare providers should ensure wound-related pain control for every patient


Table 1 – Wound pain consensus principles (taken from[6] — WUWHS, 2007).


factors that are responsible for skin texture[10]


. In their study, Dykes et al attached five


types of adhesive dressings to the subjects’ forearms — which had been painted with dye — then investigated how much dye came off when the dressings were removed[11]


. Another study[12] attached various types


of adhesive dressings to patients’ forearms after the corneocytes in the stratum corneum had been stained with dye. The degree of corneocyte attachment found on removal of the dressings varied greatly and demonstrated the importance of dressing selection in the treatment of chronic wounds.[12] Both studies showed that soft silicone


dressings caused less damage to the skin surface than other tested products. Since the case featured in this article involved secondary hyperalgesia in the skin surrounding the ulcer, soft silicone dressing material was used following debridement.


CONCLUSION Chronic wound-related pain negatively affects wound healing. Clinicians should endeavour to understand the physiology of pain and recognise the differences between acute and chronic pain. Although patients’ most important concern is


antimicrobial activity[9] — it has a broad References


9. Harding K, Gottrup F, Jawień A, et al. A prospective, multi-centre,


randomised, open label, parallel, comparative study to evaluate effects of AQUACEL® Ag and


Urgotul® Silver dressing on healing of chronic venous leg ulcers. Int Wound J 2012; 9(3): 285–94.


10. Middleton JD. The mechanism of water binding in stratum corneum. Br J Dermatol 1968; 80: 437–50.


11. Dykes PJ, Heggie R, Hill SA. Effects of adhesive dressings on the stratum corneum of the skin. J Wound Care 2001; 10: 7–10.


12. Matsuzaki K, Kumagai N. Skin suture in critical limb ischemia patients and pain management [Japanese].


Keiseigeka [Jpn J Plast Surg] 2009; 52: 1333–41.


spectrum of activity and inactivates almost all known bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin- resistant Enterococcus. No cases of bacterial resistance have been documented in the use of silver[8]


silver was applied to the ulcer base.


Principle 4: select an appropriate method of wound debridement Debridement is mainly classified into autolytic, enzymatic, biological, mechanical, surgical, and wet-to-dry methods[4]


. A


surgical method was selected because removal of the exposed proximal phalanges was required.


Principle 5: choose dressings that minimise trauma/pain The stratum corneum constitutes the outer surface of the skin and acts as a barrier to protect deeper tissue. The cells that make up the majority of the stratum corneum (corneocytes) contain natural moisturising


50 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012


often the relief of pain, wound-related pain can be underestimated by clinicians and afforded a lower priority than other wound-healing issues. One international consensus document presents 10 statements, which can be used as strategies for minimising pain at dressing–related procedures[4]


. Therefore, a Hydrofiber dressing with


According to each of these statements, wound- related pain can be reduced by a combination of accurate assessment, suitable dressing choice, skilled wound management, and appropriate analgesic provision.


CONFLICT OF INTEREST The author has no conflict of interest to declare.


AUTHOR DETAILS Kyoichi Matsuzaki, MD, PhD, Department of Plastic and Reconstructive Surgery, Kawasaki Municipal Tama Hospital, Kawasaki, Japan; Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.


.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64