Managing Pain in Chronic Wound Care: A Comprehensive Approach

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Patients suffering with a chronic wound experience pain from an individualized perspective. Each persons’ pain tolerance varies greatly depending on their current lifestyle, stressors, comorbidities, past experiences, and own DNA factors. (9-10) When meeting a patient either for the first time or at follow-up, the clinician should perform a comprehensive pain assessment. Remember, wound care is not just treating the hole in the patient, rather it is treating the patient as a whole, including - but limited to - their pain.
A comprehensive assessment includes physiologic, sensory, affective, cognitive, behavioural and sociocultural dimensions as stated by Ahles and McGuire. (11) When assessing the patient, remember that the above dimensions …show more content…

For example, non-verbal patients cannot vocalize that their pain is an 8 out of 10 on a numerical pain scale. This population requires use of the checklist of nonverbal pain indicators (CNPI) where the patients movements or facial grimaces may indicate pain. Dementia patients also may not be able to vocalize correctly and could benefit better pain management with the Abbey Pain Scale Assessment of Discomfort in Dementia (ADD) protocol. (10) Once an assessment tool has been chosen, the same tool should be used at each follow-up for accurate reassessments. Knowing your clients and their individualized needs ensures pain is properly assessed and therefore properly …show more content…

(9-10) Anticipatory pain has been linked to higher levels of anxiety and is noted to create more pain for the patient through a nocebo hyperalgesia effect. (10) Stress can be as simple as fear of the pain felt from removing a bandage, to stress over how the patient will pay for treatments when they can barely pay for food. Although some stressors cannot be relieved by the clinician, fears and anxiety can be relieved by explaining the procedure, allowing the patient to take analgesics before treatment, selecting atraumatic dressings, and encircling the patient in the wound care process. (9-10) Addressing the holistic side with therapeutic touch or meditation can alleviate aspects of pain not relieved by medication. Educating the patient in their pain management addresses any apprehensions or misconceptions they may have while integrating the patient into the care team.

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