Pain Management

Local Wound Care and Pain Management

• Consider the temperature of wound cleansers to facilitate the person’s comfort.
• Consider superficial critical colonization (localized infection) or deeper and surrounding infection (systemic infection) as a source of pain, and manage the infection accordingly.
• Soak dressings that adhere to the wound edges prior to removal to help minimize pain.
• Keep the wound bed moist and the pressure injury covered with an appropriate, non-adherent dressing to help minimize pain.
• Choose dressings that reduce the need for dressing changes (e.g., foam, alginates, hydrocolloids, and hydrogels) or that may be embedded with analgesia or anti-inflammatory medication, including topical opioids, topical anaesthetics, or ibuprofen.
• Choose dressings that do not exert unnecessary pressure on the wound.
• Allow the person to declare “time out” periods during painful procedures.
• Administer additional medication prior to painful procedures (e.g., dressing changes, debridement).
•  Encourage the person to reposition to help minimize pain.
• Use appropriate support surfaces to help minimize pain.
• Address anticipatory anxiety and other psychosocial challenges prior to local wound care procedures.

Pharmacological and Non-Pharmacological Pain Management

• If the person wishes to receive pain medication (e.g., prior to dressing changes or debridement), administer pain medication using the World Health Organization (WHO) Pain Dosing Ladder.
• In general, start with non-opioids and, if pressure injury pain continues, consider the addition of opioids to the pain management care plan. Tricyclics and gabapentin should be considered for neuropathic pain.
• Apply non-pharmacological pain management strategies in accordance with the person’s wishes (e.g., music, progressive relaxation, TENS, visualization techniques, imagery, therapeutic touch and other holistic therapeutic modalities).

Pain Management Resources

• Refer the person to pain services and other clinical resources if additional pain management is required.
• Educate the person and his/her primary caregivers on pain assessment and management strategies.
• Refer the person to his/her family doctor to manage wound-related pain (e.g. following discharge home).