Ask the treatment expert ... about the relationship of pain and wounds

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Susan Wickard, RN, BSN, CWCN, CWS, CLNC
Susan Wickard, RN, BSN, CWCN, CWS, CLNC

How can we best identify pain associated with wounds?

All it takes is to witness the grimace on the face of a resident while changing a dressing to appreciate that pain can be associated with wounds.  

Wound pain can indicate that swelling or infection is present.  Underlying tissue destruction may be present with pain. Pain also can be associated with venous ulcers.

Chronic pain can affect the resident's quality of life in a very negative way. Lack of sleep, anxiety, fatigue, lack of appetite and depression are a few of the effects of chronic pain.

Daily living also may be affected due to the pain interfering with the resident's movement and motivation. 

Because some residents, especially those with dementias, may be unable to effectively communicate verbally, watching for signs of pain becomes important. Facial grimaces, retraction or exaggerated movement in bed are among the signs to note. 

It is important to be able to determine a resident's pain level. “A Clinical Guide to Skin and Wound Care” has 10 points to consider in the assessment data collection.*

1. Pain intensity 

2. Location

3. Quality, patterns of radiation and character

4. Onset, duration, variations and patterns

5. Alleviating and aggravating factors

6. Present pain management regimen and effectiveness

7. Present pain management history

8. Effects of pain

9. Patient's pain goal

10. Physical examination and observation of the pain site

* Hess, Cathy Thomas, Clinical Guide to Skin and Wound Care, Seventh Edition, Lippincott Williams &Wilkins, 2013. Page 32.

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