Pain is defined as physical sensation of discomfort or suffering that is associated with a bodily disorder, such as an injury or a disease. Patients respond very differently to all types of pain.
Causes of Wound Pain
Wound pain is divided into two categories: nociceptive and neuropathic. According to the World Union of Wound Healing Societies, wound pain can be caused by tissue damage (nociceptive pain) or a dysfunction of the nervous system (neuropathic pain). Both types of wound pain have unique origins and characteristics and both respond differently to treatment modalities.
Types of Pain
- Nociceptive pain presents as sharp or stabbing in nature. This pain is the response to tissue damage, which alerts the involved nerves to send a message to the brain indicating pain.
- Neuropathic pain presents as burning, tingling or shooting sensations in the affected area and is the root of chronic pain. This pain originates from damage or dysfunction of the nervous system.
Signs and Symptoms
While nociceptive and neuropathic pains serve as the medical basis for pain, there are varying symptoms of pain and day-to-day causes, as explained below:
- Background pain can be an intermittent or continuous nagging pain at the site of a wound, even at rest.
- Incident pain occurs at the wound site throughout the day during simple activities such as sneezing, coughing, walking or changing position.
- Procedural pain is directly related to activities and procedures like a daily wound dressing change.
- Operative pain comes from an invasive wound intervention like wound debridement or a biopsy.
Treatment and Management Options
Acute wounds are those that require an intense treatment protocol to aid healing in the short term. According to the principles of surgery, an acute wound that has failed to heal within four to six weeks, should generally be considered a chronic wound. There are different protocols suggested for treating and managing acute and chronic wounds but both have the same goal: improved healing and the overall outcome.
Analgesia
Progressive evaluation of analgesic pain management should begin with non-steroidal anti-inflammatory (NSAID) medication like Ibuprofen. Progressing to a mild opiate and then a more potent opiate, if needed, bears caution as they can be addicting. Researchers have found that anticonvulsant drugs can also be helpful for wound pain control.
Using topical anesthesia before a dressing change can help a patient tolerate the sometimes grueling procedure. A more invasive anesthesia-based choice is undergoing a regional or epidural nerve block or a lumbar sympathectomy to control chronic and debilitating wound pain.
Non-pharmaceutical Interventions
Other non-invasive, non-pharmaceutical pain control options include: transcutaneous electrical nerve stimulation (TENS), ultrasound therapy and pulsed radio frequency energy (PRFE). These modalities work either by stimulating tissue and reducing the pain.
Dressing Change Procedures
Involving the patient in pain control choices and actual dressing change procedures can help allay anxiety and actually aid in the healing process. A simple distraction like listening to music can sometimes be enough to carry the patient comfortably through a dressing change. Working to develop a combination of pain relief treatments to accommodate a patient's pain before beginning a dressing change will dramatically increase the overall experience and effectiveness of the healing process.
Infection Control
Preventing and controlling wound infection is critical. An infected wound dramatically increases the intensity of wound pain. Depending upon the wound condition and drainage culture results, antimicrobial and antibiotic therapies can be effective for reducing infection and associated pain. Intravenous or oral antibiotic may be prescribed. Topical antimicrobial therapy during a standard dressing change is also a viable option to treat a wound infection, based upon the wound condition and evidence of bacterial infection.
Wound pain can dramatically impact a patient's quality of life. There are many treatment options, non-pharmaceutical, pharmaceutical, non-invasive, invasive, palliative and aggressive from which to choose. Under the direction of your health care provider, there are options for controlling acute and chronic wound pain. It may take a few different trials to find what works best for each patient and each unique clinical situation. The patience and clinical expertise of your health care provider, along with the patient's involvement in the process, will find the best and most effective choice.
