An introduction to the biopsychosocial complexities of managing wound pain
Abstract
Using the Manchester pain management model (PAIN), this review discusses the care of acute and chronic wounds, focussing on the particular skills required to manage pain associated with different types of wounds, and addressing the important area of dressing change. Acute and chronic wounds can be associated with either acute or chronic pain, making management of wound pain a significant challenge. Pain can be of either nociceptive or neuropathic origin, and the longer it has been present, the more likely that psychological, social or cultural determinants influence the reactions seen in the patient. Understanding the biopsychosocial and cultural elements of pain enables the practitioner to prepare, assess, intervene and normalise effectively, during all aspects of wound care management. Utilising individualised evidence-based practice is essential to ensure that high-quality care is delivered in this key area.
References
- 1 The management of patients' pain in wound care. Nurs Stand. 2005; 20: 7, 65–73. Crossref, Medline, Google Scholar
- 2 Treating patients with painful chronic wounds. Nurs Stand. 2008; 23: 10, 42–46. Crossref, Medline, Google Scholar
- 3 Wound management and pain control. Nurs Stand. 1999; 14: 6, 47–54. Crossref, Medline, Google Scholar
- 4 Pain and tissue trauma during dressing change. Nurs Stand. 2000; 14: 40, 71–73. Crossref, Medline, Google Scholar
- 5 Principles and Practice of Managing Pain.
A Guide for Nurses and Allied Health Professionals . Open University Press, 2010. Google Scholar - 6
Pain . Creative Approaches to Effective Management (2nd edn). Palgrave Macmillan, 2009. Google Scholar - 7
Pain terms and taxonomies of pain . In:Fishman, S.M. ,Ballantyne, J.C. ,Rathmell, J.P. (eds).Bonica's Management of Pain (4th edn). LWW, 2010. Google Scholar - 8 The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007; 133: 4, 581–624. Crossref, Medline, Google Scholar
- 9 Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain. Pain. 2007; 127: 1–2, 52–62. Crossref, Medline, Google Scholar
- 10
Anatomy and Physiology (2nd edn). Pearson. Benjamin Cummings, 2005. Google Scholar - 11 Chronic pain may change the structure of the brain. Pain. (2008) 137: 1, 7–15 Crossref, Medline, Google Scholar
- 12 IASP, 2011. Available from: http://tinyurl.com/85c2dom. Google Scholar
- 13 Pain in men wounded in battle. Ann Surg. 1946; 123: 1, 95–105. Crossref, Google Scholar
- 14 Cultural components in responses to pain. J Social Issues. 1952; 8: 4, 16–30. Crossref, Google Scholar
- 15 A review of the literature on care of clients in pain who are culturally diverse. Int Nurs Rev. 2004; 51: 1, 47–55. Crossref, Medline, Google Scholar
- 16 The influence of ethnic concordance and discordance on verbal reports and nonverbal behaviours of pain.
Pain . 2011; 152: 9, 2016–2022. Google Scholar - 17
Pain management: An interdisciplinary approach . Churchill Livingstone, 2000. Google Scholar - 18 The pain catastrophizing scale: development and validation. Psychological Assessment. 1995; 7: 524–532. Crossref, Google Scholar
- 19 Pain catastrophizing and consequences of musculoskeletal pain: A prospective study in the Dutch community. J Pain. 2005; 6: 2, 125–132. Crossref, Medline, Google Scholar
- 20 Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain. 2005; 113: 3, 310–315. Crossref, Medline, Google Scholar
- 21 Expressing and responding to pain and stoicism in home-care nurse-patient interactions. Scand J Caring Sci. 2006; 20: 3, 293–301. Crossref, Medline, Google Scholar
- 22 Psychological approaches in the treatment of chronic pain patients— when pills, scalpels, and needles are not enough. Can J Psychiatry. 2008; 53: 4, 213–223. Crossref, Medline, Google Scholar
- 23 The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 6, 361–370. Crossref, Medline, Google Scholar
- 24 Review of the relationship between stress and wound healing: part 1. J Wound Care. 2009; 18: 9, 357–366. Link, Google Scholar
- 25 Managing stress and pain to prevent patient discomfort, distress and delayed wound healing. Nurs Times. 2010; 106: 16, 21–23. Medline, Google Scholar
- 26 Assessment and management of persistent (chronic) and total wound pain. Int Wound J. 2008; 5: 2, 205–215. Crossref, Medline, Google Scholar
- 27 Re-thinking pain educational strategies: Pain a new model using e-learning and PBL. Nurse Edu Today. 2010; Epub. Google Scholar
- 28
Acute Pain Management: Scientific Evidence (3rd edn). ANZCA, 2010. Google Scholar - 29
Improving efficiency and patient satisfaction in a tertiary teaching hospital preoperative clinic . Anesthesiology. 2010; 112: 1, 66–72. Google Scholar - 30 Assessment of pain. Br J Anaesth. 2008; 101: 1, 17–24. Crossref, Medline, Google Scholar
- 31 Assessment and management of acute pain in adult medical inpatients: a systematic review. Pain Med. 2009; 10: 7, 1183–1199. Crossref, Medline, Google Scholar
- 32 Recent advances in the pharmacological management of pain. Drugs. 2007; 67: 15, 2121–2133. Crossref, Medline, Google Scholar
- 33
Managing pain and stress in wound care . In:Upton, D. (ed).Psychological Impact of Pain in Patients with Wounds . Wounds UK, 2011. Google Scholar - 34 The use of the pain coping strategies in low back pain patients: relationship to patient characteristics and current adjustment. Pain. 1983; 17: 1, 33–44. Crossref, Medline, Google Scholar
- 35 The short-form McGill Pain Questionnaire. Pain. 1987; 30: 2, 191–197. Crossref, Medline, Google Scholar
- 36 Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994; 23: 2, 129–138. Medline, Google Scholar
- 37 The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005; 6: 3, 149–158. Crossref, Medline, Google Scholar
- 38 Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2011; 1: CD008242. Google Scholar
- 39 Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2011; 3: CD007938. Medline, Google Scholar
- 40 Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009; 3: CD007076. Medline, Google Scholar
- 41 Intrinsic mechanisms of pain inhibition: activation by stress. Science. 1984; 226: 4680, 1270–1277. Crossref, Medline, Google Scholar
- 42 The management of patients' pain in wound care. Nurs Stand. 2005; 20: 7, 65–73. Crossref, Medline, Google Scholar
- 43 The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomised controlled clinical trial. Eur Heart J. 2002; 23: 8, 666–674. Crossref, Medline, Google Scholar
- 44 Repeatability of autonomic responses to pain anticipation and pain stimulation. Eur J Pain. 2006; 10: 7, 659–665. Crossref, Medline, Google Scholar
- 45 Does anticipation of pain affect cortical nociceptive systems? J Neurosci. 2002; 22: 8, 3206–3214. Crossref, Medline, Google Scholar
- 46 Psychological stress and pain in wound care, part 3: management. J Wound Care. 2010; 19: 4, 153–155. Link, Google Scholar
- 47 The analgesic effects of low concentrations of nitrous oxide compared in man with morphine sulphate. J Clin Invest. 1943; 22: 871–875. Crossref, Medline, Google Scholar
- 48 Analgesia for venepuncture in a paediatric surgery centre. J Paediatric Child Health. 1995; 31: 6, 542–544. Crossref, Medline, Google Scholar
- 49 A discussion of the potential mechanisms for wound dressings' apparent analgesic effects. J Wound Care. 2010; 19: 10, 424–430. Link, Google Scholar
- 50 Impact of atraumatic vs conventional dressings on pain and stress. J Wound Care. 2012; 21: 5, 209–215. Link, Google Scholar