Factors associated with high pain intensity during wound care procedures: A model.

The most common wound care procedures (WPCs) performed on open wounds are dressing changes and wound cleansing. Dressing changes cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8-10 on a 10-point numeric rating scale). The purpose of this paper is to propose a model of clinically accessible factors that can be tested in order to develop a clinical tool to identify which patients are likely to experience high intensity pain during nonoperative WCPs, such as dressing changes. Although multiple factors are known to be associated with pain, the factors selected for this model were limited to those that (1) are supported based on evidence and/or pain mechanisms and (2) are readily accessible to clinicians/practitioners and can be tested as a prediction tool to be used prior to WCPs. This model may be helpful to identify those likely to experience high intensity pain during WCPs. In this way, use of aggressive pain management strategies, including specialty dressings, pharmacologic analgesics, and/or non-pharmacological strategies, such as high intensity transcutaneous electrical stimulation.

HI-TENS reduces moderate-to-severe pain associated with most wound care procedures: a pilot study.

This study systematically examined pain associated with wound care procedures (WCPs) and evaluated the effectiveness of high-intensity transcutaneous electrical nerve stimulation (HI-TENS) for reducing this pain in a two-phase design. Phase 1 (N = 57) examined patient, wound, and procedural factors, as well as analgesic intake, associated with WCPs. Pain during the WCPs was rated on a 0-10 numerical scale. Subjects reported a mean pain of 6.0 (standard deviation 3.04) during Phase 1, with 43 (75.4%) subjects experiencing moderate or severe pain (i.e., ≥4). Subjects who received opioid and/or nonopioid analgesia 1 hr before or during the WCPs (36.8%) reported significantly higher pain levels than those who had not received analgesia (p = .013). In Phase 2, 23 subjects with ≥4 pain during Phase 1 had HI-TENS applied to the area surrounding the wound during the WCPs. HI-TENS significantly reduced WCP pain by a mean of 2.0 (±2.31; effect size = 0.67; p = .001). This effect was significant for subjects with severe Phase 1 pain (i.e., ≥8; effect size = 1.00; p = .007) but not for subjects with moderate Phase 1 pain (i.e., 4-7; effect size = 0.40; p = .053). These findings demonstrate that pain during WCPs is a significant problem, that nurses appropriately administer analgesics but these are not sufficient, and that using HI-TENS may further reduce pain, particularly in patients experiencing severe WCP pain.