I am treating a patient with two Stage IV pressure ulcers and he is complaining of extreme pain. What do you recommend?

Many published studies have indicated patients can experience soreness, aching, throbbing and generalized pain in the area of the pressure ulcer. The patient may experience pain just prior to the actual tissue breakdown over the site that eventually becomes a pressure ulcer. 

Pain can  be intermittent or continuous. It may or may not be associated with the dressing change, or occur at intervals unrelated to procedures.

It can occur with movement such as simple turning and repositioning. Continuous, scheduled pain assessments are necessary. It is also important to assess pain before, during and after each dressing change. 

Use standardized pain assessment tools. There is a “Numeric Pain Intensity Scale,” in which the patient rates the level of pain based on a numeric scale, with 0 indicating no pain. If the patient is not able to verbally express his or her thoughts and feelings, use the “FACES Pain Rating Scale.” A “happy face” represents no pain while the face image with a large frown and large tears indicates the worst possible pain.

The clinician must determine when the pain occurs, implement a plan of action to reduce or alleviate the pain, and document the results. Analgesics administered prior to procedures, along with other soothing relaxation methods, may reduce the pain.