CHICAGO — Nonsurgical patients reported greater pain than did surgical patients during dressing changes and when having two or more treatment procedures, said Nancy Stotts, R.N., Ed.D., at the annual meeting of the Wound Healing Society.
She and her colleagues conducted a study of pain in 412 hospitalized adults at multiple locations, 74% of whom were surgical patients. Most of the patients were male (53%) and white (74%), and had chest wounds (60%). The average wound was 11.8 cm long and 2.5 cm deep.
Of the 412 patients, 93 (23%) were premedicated, and 19 (5%) received pain medications during wound care. Only 7.3% of the surgical patients and 5.9% of the nonsurgical patients received analgesics after their dressings were changed, noted Dr. Stotts, a professor of physiological nursing at the University of California, San Francisco.
Opioids were the most common medications, and the mean dose was 6.8 mg for surgical and nonsurgical patients alike. Sedatives and NSAIDs were rarely used in this patient population, Dr. Stotts said.
The patients' subjective experience of pain was measured using a numeric rating scale (NRS), on which 0 equals no pain and 10 equals the worst possible pain. Patients' pain scores were measured before, immediately after, and 10 minutes after the wound care procedures, which included dressing change, debridement, packing, and irrigation.
Overall, the patients reported the most intense pain during a wound care procedure, when the average NRS score was 4.4.
Nonsurgical patients reported significantly greater pain than did surgical patients, with average NRS scores of 5.3 and 4.1, respectively.
The higher pain scores in the nonsurgical patients were associated only with dressing changes and with undergoing two or more wound care procedures.
“Pain intensity did not differ with age, sex, or race,” Dr. Stotts observed.
When patients were given a choice of words that described their pain, the word “stinging” was often used to describe debridement; “stabbing” and “sharp” were often used to describe pain associated with any wound care procedure.
In addition to pain medications, patients and nurses used techniques such as humor, distraction, and deep breathing to manage pain during wound care procedures.
Pain seems to be undertreated in the hospitalized population, although it may be managed more effectively in surgical patients, Dr. Stotts said.
Further research on the effect of pain on wound-related patient outcomes could help develop pain management strategies, she added, pointing out that current data are limited.