Strategies for wound pain management
This excerpt was taken from the book, Evidence-Based Pressure Ulcer Prevention: A Study
Guide for Nurses
Nurses must meet the challenge of assessing and managing their patients' pain effectively as it is
important for both the prevention and healing of pressure ulcers. The key to managing wound
pain is to use a validated pain scale to regularly assess those patients with open wounds and
pressure ulcers for pain. If the pain is frequent or constant, consider giving a scheduled pain
medication. If the patient has an order for “as needed or as required” analgesics, give them at the
earliest sign of pain; do not wait for the pain to get out of control. Remember to evaluate the
patient’s response to pain-relieving medication.
For optimal pain relief during dressing change, consider using the following strategies:

Offer analgesics when pain is anticipated. Premedicate the patient at least one hour before
dressing change or debridement. Evaluate the patient’s response by assessing the
effectiveness of the medication during the procedure. If the procedure is exceedingly
painful, a stronger premedication may be needed. Another option is to use a topical
product, such as one containing lidocaine. Such products are highly effective but take
approximately two hours to work.

Dispel myths and teach the patient facts about pain and pain management. For example,
the old adage “no pain, no gain” is a myth. Teach the patient that in wound healing, less
pain means more gain. Another common myth is that responsiveness to pain decreases
with age. Many nurses believe that pain perception decreases, and elderly patients
increase their complaints. But sensory processing of painful stimuli does not change with
age. Older adults experience many painful chronic diseases. Indeed, they may experience
more pain than younger adults.

Involve the patient in decision-making, and give him or her a sense of personal control
over the pain.

Provide antianxiety medications, if requested by the patient.

During the dressing change, monitor the patient’s body language and nonverbal cues
carefully for signs of pain.

Avoid unnecessary manipulation of the wound. Protect it from sources of irritation,
including air flow from a fan or window.

Warm the cleansing solution prior to cleansing the wound, if possible.

Use only normal saline or pH-neutral wound cleansers. Be gentle when cleaning the
wound.

Allow the patient to stop and rest during a painful procedure, such as a dressing change.
Agree on a signal in advance.

Match the dressing and treatment product to the wound. Use dressings that are
nonadherent and reduce pain. Avoid woven cotton gauze, which is highly irritating to
sensitive skin.

Select wound products that maintain a moist environment in the wound bed. Do not allow
the wound to become desiccated.
Select treatments that can remain in place for a prolonged period of time. Avoid frequent
dressing changes by using advanced products, if possible.


Consider contact-layer dressings that remain in place. Doing so decreases the need to
manipulate the tender wound bed, which causes increased pain.

Use compression bandages, if needed, to reduce edema and relieve pain.

Apply barrier products to protect the wound margins, thus preventing maceration and
further breakdown. This is particularly important if chemical debriding agents are being
used.

Allow the patient to remove his or her own dressing, if desired.

Remove tape and dressings carefully and gently. If the dressing or tape sticks to the skin
during dressing removal, apply normal saline, and then wait a few minutes.


Minimize the use of tape if the patient’s skin is sensitive, or if he or she is at risk for skin
tears.
Instead, use bandages, Montgomery straps, Coban wrap, etc., to cover the dressings.

Follow manufacturers’ instructions for removal of hydrocolloids and transparent films.

Splint or immobilize the wound during movement and treatment, if possible.

Teach patients to use relaxation and distraction techniques, such as guided imagery; slow,
deep breathing; biofeedback; and listening to comforting music through a headset.
Pain management tip
Provide pain management by eliminating mechanical sources of pain (e.g., choosing a dressing
that can be changed once daily versus multiple changes during the day, or adjusting the support
surface/repositioning plan). Collaborate with the patient’s physician regarding analgesia and, if
pain is severe, talk to the physician about a pain management service consultation, if available.
Remember: New onset pain may be a sign of wound infection.
Editor’s note: This excerpt was taken from the book, Evidence-Based Pressure Ulcer Prevention:
A Study Guide for Nurses. To find out more about the book and to order a copy visit
http://www.hcmarketplace.com/prod-6133.html.