Ask the treatment expert: recommendations for addressing wound pain

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Ask the treatment expert
Ask the treatment expert
Do you have any recommendations for addressing wound pain?

First, try to determine the source of the wound pain: location, aggravating factors, intensity, duration, etc. This will help as you choose what type of interventions to try. Wound pain can be caused by trauma, dressing changes, exposure of the wound to air, medication burning, cleansing pain, a disease process, infection or even the underlying factors that caused the wound. As with any type of pain, the pain is whatever the resident says it is.  
For pharmaceutical interventions, you should follow the “WHO” (World Health Organization) analgesic ladder.

Step 1 - Mild to moderate pain, treat with non-opioid analgesic e.g.: NSAIDs, acetylsalicylic acid and acetaminophen

Step 2 - Moderate to severe pain; Step 1 medications plus codeine

Step 3 - Severe pain; Step 1 medications with morphine (skip step 2 meds)

Non-pharmaceutical interventions may include:

• Offloading and pressure reducing devices to bony prominences

• Elevation of legs to reduce edema-related pain

• Bed cradle to lift weight of bed linens off hypersensitive areas

• Splinting to immobilize injured tissues

• Transfer-assist devices to reduce pain during transfers

• Use lift sheets to avoid friction shear pain

• Allow for timeouts during painful procedures

• Allow patient to perform his or her own dressing changes

• Schedule dressing changes when the patient is feeling best

• Pre-medicate with analgesic and schedule dressing changes during peak effects of the medication