Managing Pain with Dressing Changes

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F-Tag 309 is a government regulation that deals with pain stating: “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care”. (1)

How does this relate to wound pain? Pain related to wounds can be a result of day-to-day activities or dressing changes and wound procedures such as debridement. The presence of a wound may stimulate pain pathways and increase transmission of pain impulses, resulting in wound pain. (3) For some people, dressing changes can be times of extreme pain; a 2004 French study noted that pain was experienced by 87% of patients during the dressing removal process. (4) Techniques to reduce, prevent and manage pain are necessary to maintain the highest physical, mental and psychosocial well- being of the patient. Strategies for pain management begin with:

-recognizing and predicting the instances of pain and when it is likely to occur

-proper evaluation of existing pain

-implementing treatments and techniques to manage and prevent pain (2)

Managing wound pain includes an assessment rating the intensity, quality, and location of pain. In addition, nonverbal cues such as facial grimacing, guarding the area, restricted movement, noting if the pain radiates to other areas and factors that may aggravate or relieve pain are critical to a complete pain assessment. The nonverbal resident presents additional challenges in pain assessment, so include input from primary caregivers related to previous wound pain when needed. Residents that have experienced wound pain previously with dressing changes may anticipate pain and become tense and anxious, resulting in more pain at dressing change. (3) Treatment interventions to minimize dressing change pain include:

-Explaining prior to the dressing change, what can be expected, and the interventions that will be used to minimize pain.

-Using music, deep breathing techniques and relaxation exercises to reduce anxiety prior to dressing changes.

-Utilizing products such as skin prep before applying adhesive dressings and practicing gentle techniques to avoid trauma when removing adhesive dressings and tape.

-Avoid using plain gauze dressings, which are known to cause pain due to adherence of the dressing to the wound bed.

-Administering prescribed medications for pain control then allowing adequate time for the medications to be effective before beginning dressing changes.

-Selecting a dressing that suits the drainage level of the wound: hydrogels, alginates, or silicone dressing scan promote moisture balance, minimize adherence and adhesive related  skin stripping, which can decrease the occurrence of pain during dressing changes. (3)

DermaRite’s ComfortFoam self-adherent silicone foam wound dressings minimize the wound trauma and pain associated with dressing changes. ComfortFoam Border and ComfortFoam Border Lite dressings include an adhesive border for superior adhesion and gentle removal. ComfiTel is a silicone contact layer wound dressing that permits wound exudate to pass through to a secondary absorptive dressing, protecting the wound bed from trauma while providing comfort. The ComfortFoam line of silicone products support moist wound healing and provide protection to fragile periwound tissue. The foam dressings absorb exudate and insulate the wound bed. ComfortFoam dressings and ComfiTel are not made with natural rubber latex. ComfortFoam and ComfiTel should be part of your solution to reduce painful dressing changes for your residents.

References1. “Pain F-Tag (309).” Pain F-Tag (309). 07 July 2016. http://www.geriatricpain.org/Content/Resources/Regulations/Pages/PainF-Tag(309).aspx2. Swezey, L. “How to Decrease Pain Associated with Dressing Changes.” Http://www.woundsource.com/blog/how-decrease-pain-associated-wound-dressing-changes. Woundsource.com, 06 June 2013. Web. 7 July 2016.3. Browning, A. “Strategies to Reduce or Eliminate Wound Pain.” NursingTimes 110.15 (2014): 12-4. Nursingtimes.net. Web. 7 July 2016.5. Romanelli, M., and V. Dini. “Chapter 5 Assessment of Wound Pain at Dressing Change.” Web. 7 July 2016.