Preventing, minimizing, and managing pain in patients with chronic wounds: challenges and solutions

Abstract

Abstract:It is widely known that pain frequently accompanies certain types of chronic wounds, most notably arterial insufficiency ulcers, venous leg ulcers, and diabetic foot ulcers; however, until recently, pain associated with chronic wounds has not received much attention. A limited number of studies have explored the impact of painful wounds on the quality of life. Nonetheless, these early works have brought wound-related pain (WRP) to the forefront and highlighted the importance of pain assessment and management in enhancing the quality of life and improving wound healing outcomes. This review of the current literature on WRP presents an overview of pain pathophysiology, clinical features of WRP, and the limitations of pain assessment methods, and offers clinical pearls on preventing, managing, and minimizing WRP.

A randomized controlled clinical trial of a hypothermically stored amniotic membrane for use in diabetic foot ulcers

“…It has been reported that within 5 years after achieving wound closure, between 70 and 100% of these healed ulcers will re-open and require additional ulcer management treatments [9]. DFUs substantially reduce patients' quality of life, are often painful, and adversely affect mobility and sleep [10][11][12][13]. Furthermore, ulcers are significantly correlated with time lost from work, job loss and high rates of adverse effects and serious adverse events [14,15].…”

The great imitator with no diagnostic test: pyoderma gangrenosum

“…Thus, care should be provided in a warm and calm environment that will allow the patient to relax. 31 Wound debridement often presents a challenge in PG because of its feature of pathergy, or exacerbation in response to incidental or iatrogenic trauma. 39 For this reason, surgical debridement is not generally recommended.…”

“…Another important aspect of treatment is the pain, which should be addressed depending on the intensity of pain, initially with oral administration of acetaminophen and nonsteroidal anti‐inflammatory drugs for nociceptive pain (gnawing, aching, tender, and/or throbbing pain), then as necessary mild opioids such as codeine, then strong opioids such as morphine, until the patient is free of pain 30 . The use of opioids for the treatment of noncancer pain remains controversial, thus, clinicians need to be careful to minimise abuse and to treat pain effectively 31 Initial treatment of neuropathic pain (burning, stinging, shooting, or stabbing) can be managed with gabapentin and pregabalin, along with nortriptyline at night to facilitate sleep 32…”

“…Anxiety generates an autonomic response such as muscle tension and increased heart rate, which along with past experiences may cause patients to perceive greater pain. Thus, care should be provided in a warm and calm environment that will allow the patient to relax 31 …”

<p>Treatment Of Pain In Wounds With A Topical Long Acting Lidocaine Gel</p>

“…The former leads to addiction, dependence, and tolerance while the latter causes a ceiling effect. 10,11 To overcome the issue, topical anesthetics are widely used to numb the skin and to relive pain in medical and surgical procedures in anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. Among topical anesthetics, lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel are commonly available as prescription and/or over-the-counter (OTC) products.…”