Assessment and management of pain in chronic wounds: a national survey of Australian health care practitioners caring for people with chronic wounds

Abstract

Background: Pain is a frequent symptom and a major issue for people suffering chronic wounds and has a significant impact on the patient's quality of life. Ineffective wound pain management can result in delayed healing and lack of compliance by the patient. Pain during wound dressing changes is usually well managed, however chronic persistent wound pain is under-assessed and under-treated, resulting in patients' perception that wound pain is something they have to suffer or manage by themselves1. The aim of this study was to investigate wound health care practitioners' assessment of chronic persistent wound pain. It sought to determine 1) when and how pain is assessed and 2) what pain management strategies are used. Methods: A custom designed survey tool was developed to identify variables in wound pain assessment and management, including place of work, wound locations, when and how wound pain is assessed, is pain managed in wound care and how. The questionnaire was distributed as a national mail survey of members of the Australian Wound Management Association (n=2350). A 51% response rate was achieved and included nurses, podiatrists and doctors. A cross sectional descriptive analysis was conducted to characterise and compare chronic wound pain assessment and management between the different disciplines of health care professionals. Results: The majority of health professionals (98.5%) do ask patients about wound pain. Methods routinely used to assess pain were a combination of body language, facial expressions and talking to the patient and/or self-report pain rating scales. The Numerical Rating Scale was the most common tool used either alone or in combination (46%) Differences were found between professions in when patients are asked about wound pain (χ2 =102.86, df 50, P <0.001); how pain is identified (χ2=59.57, df 50, P <0.001) and the preference of pain assessment tool used (χ2=47.16, df 20, P <0.001). Wound pain assessment methods differed according to the anatomical location of the wound (χ2=47.49, df 24, P <0.001). Several main issues were raised linking wound pain and limitations in providing effective wound pain management. Conclusion: This study identified that various methods of assessment are utilised to identify pain in chronic wounds, however barriers exist that impact the implementation of effective pain management. The frequency of assessment and methods used differed according to wound location and health professional discipline. A consistent approach of wound assessment and management strategies for persistent chronic wound pain should be an integral component of wound assessment by all health professionals to improve wound healing.