Wound infection & pain management made easy
25/05/10 | Infection, Wellbeing and concordance, Wound bed preparation | Mudge E, Orsted H
Wound-related pain is common, highly subjective [1-4] and can be particularly distressing for both patients and clinicians . It has multiple causes and, unfortunately, is often managed inadequately[6,7]. This article discusses wound infection as a cause of pain, outlines strategies for effective pain management, and considers the role of antimicrobial dressings in minimising or preventing pain when a wound is infected.
WHAT CAUSES PAIN IN WOUNDS?
Pain is a common experience for patients with wounds. Some wounds are generally more painful than others, and this may be associated with the underlying aetiology, eg ischaemia in arterial ulcers .
At a physiological level, wound pain arises from tissue damage (nociceptive pain) or from dysfunction of the nervous system (neuropathic pain) (Box 1). Pain from chronic wounds may have both nociceptive and neuropathic elements .
Box 1 (click image to enlarge)
There are many triggers of wound pain. Tissue damage as a result of trauma, particularly during the dressing change procedure, has been described by patients as the worst part of living with a wound .
Wound pain has numerous, often interlinked, causes that may relate to:
- the wound itself, eg the initial injury, the inflammatory response or infection
- interventions, eg topical treatments (including dressings), dressing removal, cleansing, debridement or compression therapy
- other local pathology, eg oedema, allergic reactions, ischaemia or arthritis.
In addition, there are many psychological and emotional factors associated with living with a chronic wound that can exacerbate a patient's pain perception, such as anxiety, stress, fear, depression, wound malodour or high exudate levels .
Sustained pain can produce physiological changes that increase perception of pain (Fig 1). Ongoing stimulation of a pain pathway can result in increased sensitivity of peripheral pain receptors (primary hyperalgesia) and increased transmission of pain impulses to and within the brain (secondary hyperalgesia). In effect, these changes increase the amount of pain perceived to arise from a painful stimulus. Ongoing pain can also result in allodynia – the experience of pain as a result of a stimulus, eg a light touch on skin, that would not usually cause pain.
Wound pain can be categorised as:
- Background pain – continuous or intermittent pain that is felt even at rest
- Incident pain – pain that occurs during day-to-day activities such as mobilisation or coughing
- Procedural pain – pain that results from routine procedures such as dressing changes or wound cleansing
- Operative pain – pain associated with significant wound intervention, eg debridement or wound biopsy .