Wound Care Today

WOUND CARE TODAY

2016,Vol 3, No1

FOCUS ON PAIN

wound pain cannot be overlooked

regardless of caseload pressures and

demands on resources, as side-

stepping this fundamental aspect

of patient treatment potentially

removes the care from practice.

Nurses understand that there is

often no cure for wound pain;

however, by offering therapeutic

techniques and reassurance, the

patient’s pain experience can be

alleviated or improved.

REFLECTION

One of the first practical steps

in managing a patient’s pain is

being self-aware and reflecting on

practice. This requires nurses to

‘take a step back’ and ask some

searching questions about the

way in which they are managing

a particular patient (

Table 1

). In

the author’s clinical opinion, the

concept of pain management has

as much to do with exploring the

nurse’s views, judgements and

practices of managing pain, as the

phenomenon of pain itself.

Essentially, pain means different

things to different people and is

often dependent on a number of

external and internal factors. It is

a biopsychosocial phenomenon,

which means that the patient’s pain

experience, and the assessment

of pain itself, are influenced

by biological, physical, social,

emotional, behavioural, spiritual and

cultural factors (Richardson, 2012).

Roberts’ (2013) guide to

holistic nursing brings together an

abundance of literature to support

nurses in psychotherapeutic

approaches to care. He views

nursing as a therapeutic activity

and, by adapting psychotherapeutic

techniques, describes how nurses

can set the foundations for best

practice when managing wound-

related pain (

Table 2

illustrates some

of the recommended activities).

ASSESSMENT

Any assessment of wound-

related pain (see ‘Science’ box

above) should include a thorough

evaluation of:

The pain’s origins (i.e. ask the

patient where the pain is coming

from, as this may not always be

the wound itself)

Details of the pain and its

effects, both physical and

psychosocial. For example, what

does the pain feel like — is it

burning, stinging, throbbing,

stabbing continuous or

intermittent? Do certain physical

or environmental triggers

exacerbate or alleviate the pain,

i.e. the cold or heat, elevation or

dependency in the morning/at

night, etc? Psychosocially, pain

can affect a patient’s social life,

relationships, work, and overall

wellbeing (Mudge et al, 2008).

Nurses should also use a pain

scale (see details below), as well as

recording the patient’s vital signs,

any current or previous analgesia,

and any side-effects of current or

previous pain medication (nausea,

constipation, etc) (Coulling, 2007).

The World Union of Wound

Healing Societies (WUWHS, 2008)

has highlighted some useful tips

with regards to pain in wound care

(

Table 3

), as well as looking in detail

at the two types of pain, nociceptive

and neuropathic:

Nociceptive pain: the body’s

natural physiological response

to a painful stimulus, which

may involve acute or

chronic inflammation

Neuropathic pain: arises as a

result of disease or damage to

the nervous system.

As said, the psychological and

emotional aspects that can result

Top tip:

In general, it is important that

wounds are kept moist to facilitate

healing and aid dressing removal

and prevent trauma.

THE SCIENCE —

ASSESSING WOUND PAIN

The assessment of wound-related pain should

be an ongoing process, involving negotiation

and partnership between nurse and patient. It is

important that nurses note the effects of analgesia

and dressings on pain levels, as well as any subtle

changes in discomfort (Day, 2013). The underlying

aetiology of the pain must be identified if treatment

is to be successful. It is worth noting that there may

be a number of contributing factors influencing

wound pain, such as soft tissue inflammation, infection, underlying peripheral

arterial disease, and musculoskeletal or neurological disorders.Various

diagnostic tools such as Doppler assessment, Duplex scanning, X-ray,

magnetic resonance imaging (MRI) or tissue biopsy alongside microbiology

may be required to identify the underlying cause of pain.

Table 1:

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What does managing pain mean to me in practice?

What are my own thoughts about pain management?

Does my own experience of pain, or managing pain in others, affect how I assess patients’pain?

Do I regularly keep up to date with current evidence in the management of pain in wound care, or is

there anything I could do to improve my current knowledge?

Do I really listen and observe my patients when they are speaking about pain, or appear to be in pain

or discomfort?

Credit: Squeezyboy@flickr.com