PAIN

Wound pain is often underestimated, but it can be a very significant problem for the patient experiencing it. Inadequately managed pain can lead to sleep disturbance, irritability and depression. Chronic wound pain is frequently severe and persistent and quickly leads to sleeplessness, emotional distress, loss of self-esteem, social isolation and depression (Flannagan, 2007; Serena, 2016).

Measuring pain should be included as part of the patient assessment and wound evaluation. It is essential that pain is included in the ongoing assessment and incorporated into the management process.

A pain history should include intensity, quality, location(s) (including radiation), pattern (including onset, duration and frequency) and aggravating and relieving factors (Brown, 2014). Observing non-verbal cues can reveal a patient’s reaction to pain and assist in measuring their levels. In some cases, it may be necessary to gather information and a history from other sources, such as the primary caregiver (Brown, 2014).

Pain is also a marker of wound progress or deterioration. Pain may diminish as oedema resolves, whereas a sudden increase may be a sign that infection is present (Eagle, 2009; Brown, 2014).

There are a number of ways that pain can be assessed, and there are several pain measurement tools available to assist patients to convey the level of pain they are experiencing. Many of these methods rely on the self-reporting of patients, and the very nature of pain can multifaceted and subjective, leading to the pain scales possibly falling short of quantifying the pain levels (Serena, 2016).

There are several validated tools, including the McGill Pain Questionnaire, developed by Ronald Melzack in 1975, which provides a multidimensional assessment, that goes beyond assessing pain intensity (Brown, 2014; Serena, 2016). It evaluates several different components of pain: how pain changes over time and the factors that increase or relieve it (Serena, 2016). It also provides valuable insight into the type of pain the patient has and the effect on their quality of life. It offers a more considerate tool to determine any treatment-related changes.

For those patients that have dementia/Alzheimer’s, there are tools available, such as Pain Assessment for the Dementing Elderly (PADE) (Villanueva et al., 2003) and Pain Assessment in Advanced Dementia (PAINAD) Scale (Warden et al., 2003).

To assess a patient’s level of pain, a combination of a validated pain scale alongside a quality-of-life questionnaire, is an effective method to evaluate the impact of wound-related pain. Health care practitioners should also consider any signs of stress and anxiety (Serna, 2016).

It is therefore important to listen, empathise and adequately manage the patient’s pain, to prepare patients for pain that they are likely to experience and to establish a good rapport. Empowering the patient to be involved in their care can improve the patient experience. If the health professional fails to do this, the patient is likely to fear future wound intervention. The patient will also be less likely to trust the health professional’s advice and prescribed treatment regimen.

This section has shown that a thorough patient assessment is important when constructing a wound care plan. It is also important to have a good understanding of the person who has the wound so that realistic goals and outcomes can be planned.

Once a practitioner has a complete history of the patient and their wound, they will be able to plan the most appropriate course of treatment and lifestyle changes to ensure optimal wound healing.