Chronic wounds, especially when they are non-healing, are frequently painful and the pain is often inadequately treated. Pain has numerous adverse effects beyond patient suffering. Pain may impair wound assessment, debridement, cleaning, and dressing changes. Pain-induced vasoconstriction may directly impair wound healing by reducing wound oxygen levels. Wound pain may be both chronic, from tissue injury, exposed nerves, chemical irritation, and ischemia, and acute, from debridement and dressing changes. The WHO Analgesic Ladder (http://www.who.int/cancer/palliative/painladder/en/ ) is useful for determining the best approach to analgesia in a given patient. Opioids are often required for adequate pain relief until the wound begins to heal. Non-pharmacologic approaches to pain include warmth, smoking cessation, appropriate dressings, and a commitment to the patient to treat their pain.
Hopf HW, Shapshak, D, Junkins S, O’Neill DK. Managing Wound Pain. In: Bryant RA, Nix DP, eds. Acute and Chronic Wounds: Current Management Concepts, 5th Edition. St. Louis: Mosby Elsevier, 2015
O’Neill DK, Maggi J. Anesthetic care for patients with skin breakdown. Anesthesiology Clin 27 (2009) 599-603.
American Geriatrics Society Panel on Persistent Pain in Older Persons: The management of persistent pain in older persons, J Am Geriatr Soc 50(S6):1, 2002.