Assessment of pain in chronic wounds: A survey of Australian health care practitioners

Abstract

Pain associated with chronic wounds can delay wound healing, affects quality of life, and has a major impact on physical, emotional, and cognitive function. However, wound-related pain is often under-assessed and may therefore be suboptimally managed. The aim of this study was to describe the assessment practices used to assess chronic wound pain by health practitioners in Australia. A structured self-administered questionnaire was posted to members of an Australian national wound care organisation, whose membership represents various health practitioners involved in wound management. A total of 1190 (53%) members completed the survey. Overall, wound pain assessment was most commonly conducted at every consultation or wound dressing change (n = 718/1173, 61%). Nurses were more likely to assess wound-related pain before, during, and after the wound dressing procedures compared with other health care practitioners. In contrast, podiatrists assessed wound pain only when the patient complained about the pain. The most common assessment method was simply talking to the patient (n = 1005/1180, 85%). Two-thirds of practitioners used a validated pain assessment tool. The most commonly used tool was the numerical analogue scale (n = 524/1175, 46%). In summary, these findings suggest that there is no consistent method for the assessment of wound-related pain, and there are substantial variations in how and when wound-related pain is assessed between different professions.

Prevalence and factors associated with ulcer‐related pain in persons with chronic leg ulcers—an explorative study

“…There may be numerous reasons for the high percentage of severe pain in the present study, but inadequate pain management is probably a major contribution. Research indicates healthcare professionals do not comply with well‐established guidelines for best practice of wound care when it comes to pain assessment (Franck & Bruce, 2009; Frescos, 2018), and are insecure about the optimum pharmacological management of non‐malignant pain in older persons (Barber & Gibson, 2009). In addition, stoicism and fear of addiction among patient with chronic venous ulcers, may lead to a tendency to take analgesics less frequently or at a lower dose than prescribed (Sale et al, 2006).…”

“…Furthermore, pain assessment and management are identified as a main category of the ‘wound management and assessment’ area for registered nurses providing care for chronic wounds (Kielo et al, 2019). However, wound care researchers report that persistent ulcer‐related pain is either dismissed by healthcare providers or inappropriately assessed (Frescos, 2018; Green et al, 2018). Presumably, lack of knowledge (Green et al, 2018) or time (Frescos, 2018; Green et al, 2018) may be reasons for inadequate pain assessment.…”

“…However, wound care researchers report that persistent ulcer‐related pain is either dismissed by healthcare providers or inappropriately assessed (Frescos, 2018; Green et al, 2018). Presumably, lack of knowledge (Green et al, 2018) or time (Frescos, 2018; Green et al, 2018) may be reasons for inadequate pain assessment. Increased knowledge about ulcer‐related background pain and associated factors can support nurses in the provision of holistic and person‐centred care to persons with chronic leg ulcers.…”

The outcomes and experience of people receiving community‐based nurse‐led wound care: A systematic review

“…The literature review demonstrated nurse‐led wound care to reduce pain on multiple occasions, even with different methods of nurse‐led intervention. Frescos (2018) reinforced this finding, with nurses more likely to conduct a pain assessment during wound care, in comparison with other healthcare practitioners. Pain is under‐assessed and often dismissed by healthcare practitioners; therefore, pain assessment should be a priority in wound care.…”

“…Chronic wounds are susceptible to pain because of complex physiological processes involving chronic inflammation, neuropathy and infection, and up to 80% of people experience pain with chronic wounds (Woo & Sibbald, 2008). Therefore, people with chronic wounds are often more concerned about pain management rather than wound healing (Frescos, 2018). The literature review demonstrated nurse‐led wound care to reduce pain on multiple occasions, even with different methods of nurse‐led intervention.…”