Karen Lerner

In addition to treating and preventing pressure injuries, support surfaces can play a large role in helping to reduce pain and enhance sleep.

Chronic pain is the most common cause of long-term disability, the most common undertreated symptom and a large contributor to poor sleep. It is often thought that if a resident can be distracted from the pain or only has observable vital sign changes to verify their report of severe pain, that he or she does not have high pain intensity. Unfortunately, this isn’t the case.

Today, we’ve made it a standard of care to measure, assess, document and manage residents’ pain. Pain management commonly includes the use of adjunctive options like heat and cold packs, TENs, dressings, massage, exercise, acupuncture and analgesics. Yet rarely are support surfaces included. Case studies have shown that providing the right support surface to residents can help decrease pain and improve sleep.  

According to the National Pressure Ulcer Advisory Panel, a support surface is a specialized device designed for pressure redistribution, management of tissue loads, microclimate, and/or other therapeutic functions. Centers for Medicare and Medicaid (CMS) refers to support surfaces as Pressure Reducing Support Surfaces (PRSS) and categorizes them into 3 [billing] groups. Generally speaking, Group 1 PRSS prevent and reduce pressure while Group 2 and Group 3 PRSS treat and relieve pressure.

Support surfaces can effectively help manage pain by removing pressure from the body’s frame and soft tissues, promoting healthy blood flow and skin microclimate, conforming to body contours, increasing blood flow through compression and decreasing edema. These surfaces are ideal for those suffering from sleep deprivation, chronic pain as well as post-traumatic, post-operative and post-procedure pain and other physical conditions.

All support surfaces, for both seating surfaces and beds, are designed to address and reduce extrinsic pressure injury risk factors, namely pressure, shear, friction and moisture. Case studies indicate when pressure, shear, friction and moisture are reduced, several types of pain are relieved, and sleep is improved. Some of the specific features that do this include lateral rotation, alternating pressure, pulsation, low air loss, cell on cell, seat inflation, return to alternation, auto firm and self-adjusting technology. These support surface features benefit not only residents’ skin but can help reduce their pain, improve their sleep and make caregiving easier.

Pressure reducing support surface options

Lateral Rotation

The lateral rotation feature of a support surface mattress works by rotating along a longitudinal axis as characterized by degree, duration and frequency of resident turning. Along with redistributing pressure, this feature’s primary benefit is reducing pulmonary and respiratory complications. Residents who cannot tolerate manual turning and repositioning are often able to tolerate and benefit from frequent turning and repositioning and a higher degree of turning when on a laterally rotating support surface. While this feature does not negate the need for regular skin inspection, it can enable residents to sleep through the night while being turned.

Auto Firm

An auto firm or max inflation feature makes turning and repositioning easier, faster, safer, and requires less “manhandling” and thus, less resident pain. This feature hyper-inflates the air cells so they perform like rollers, making it easier to turn and reposition residents, and may require less force than traditional draw sheets and pillows. The feature may also reduce risk of caregiver injury while  improving resident and caregiver compliance to turning/repositioning protocol and assisting in resident transfers.

Alternating pressure and pulsation

An alternating pressure feature alternates pressure via cyclic changes in frequency, duration, amplitude and rate-of-change parameters. This surface alternately inflates and deflates air cells to redistribute pressure and produce a firmer surface. On the other hand, pulsation provides deeper immersion into the support surface which may help reduce swelling and associated pain. The immersion also creates a massaging or rocking effect which many residents find soothing and sleep enhancing.

Low air loss

To manage the heat and humidity of the skin (microclimate), a low air loss feature provides a flow of air under but not on the resident. As the most commonly prescribed support surface in America, it is important to realize low air loss in merely one feature of a support surface and is affected by more than liters per minute of air flow. For example, how and where the low air loss occurs, cover materials, the moisture vapor transmission rate and whether the resident is incontinent all affect the resident’s microclimate. Residents are likely to be more comfortable and sleep better when their skin microclimate is ideal and low air loss helps achieve this.

Cell on cell and seat inflate

For residents who need to be upright while in bed or to sleep, seat inflate is the ideal solution. This feature provides additional air support under the vulnerable pelvis and helps prevents “bottoming out” when the head of the bed is elevated 30 degrees or higher.  Cell on cell maintains air in the bottom half of each air cell even if the power goes out. This important cell on cell feature not only prevents fully upright residents from “bottoming out”, it means residents’ skin and bodies are resting on air – reducing pain and discomfort – even during power outages or resident transit.

Static and return to alternating pressure

When required or desired, the mattress can be put in static mode to assist the caregiver or resident. While in bed, residents require at least every 2-hour turning and repositioning thus alternation should not be interrupted for more than 2 hours. With an automatic return to alternation feature, the support surface will return to alternation even if a caregiver inadvertently forgets to disengage static. This important return to alternation feature prevents long periods of therapy disruption and assures residents are always sleeping on a comfortable support surface, helping to reduce pain and enhance sleep.

Self-adjusting technology

Self-adjusting technology enables a support surface to adjust and redistribute pressure without outside or additional power. Working on the principle of air displacement, when a resident repositions his or her weight, air moves within the mattress to surrounding cells for optimal pressure redistribution. Pain is often reduced because the support surface conforms to the shape of the resident’s body (envelopment). Many residents can turn and reposition themselves more easily on self-adjusting support surfaces than in more traditional low air loss/alternating pressure support surfaces, and these self-movements not only help reduce pain and discomfort, it helps residents sleep.

It is well established that support surfaces can help prevent and treat pressure injuries, but they can also assist with pain reduction and enhance sleep. Through clinician education and awareness, pressure reducing support surfaces can become another powerful tool used to aid those who need relief from chronic symptoms like pain and poor sleep.

Karen Lerner, RN, MSN, ATP, CWS, is the regional vice president of pressure prevention at Drive DeVilbiss Healthcare.