Wound Care: Treatment Options For Pain
Overview
The management of pain involved with wound care, particularly during dressing changes, presents challenges due to the discomfort associated with these procedures. While pharmacological pain management strategies may have adverse effects and hinder wound care and healing, non-pharmacological interventions offer an alternative approach. However, the systematic exploration of non-pharmacological therapies for pain related to wound care is lacking, despite the growing interest in these methods.
The objective of this study was to address this gap by conducting a comprehensive literature review on non-pharmacological interventions for wound care pain during dressing changes. The researchers searched across multiple databases from January 2010 to September 2022, identifying relevant studies for evaluation. Two researchers independently assessed the literature and extracted data, with a third researcher resolving any disagreements. The risk of bias in the literature was evaluated using established criteria.
The review encompassed 11 investigations involving a total of 951 participants, examining seven non-pharmacological therapies. Among these interventions, virtual reality (VR) distraction, auditory and visual distractions, foot reflexology, religious and spiritual care, and guided imagery showed promising effects in alleviating pain during dressing changes. Hypnosis therapy and jaw relaxation were noted to potentially have a weak effect.
In conclusion, effective wound care entails comprehensive pain management strategies. While non-pharmacological interventions show promise in reducing discomfort during dressing changes, the evidence supporting their efficacy is currently limited. Further research, including multicenter studies with larger sample sizes, is warranted to validate these findings. Additionally, standardized protocols for implementing non-pharmacological interventions are needed to facilitate their widespread adoption and utilization in clinical practice.
Introduction
Pain management in the context of wound care is a critical aspect of patient well-being, yet it often receives inadequate attention in clinical practice. The discomfort associated with changing wound dressings can be particularly distressing for patients, impacting their overall experience and potentially hindering the healing process. Studies have highlighted the prevalence of pain during dressing changes, with a significant percentage of patients reporting moderate to severe levels of discomfort. This is especially true for individuals with chronic wounds or extensive burn injuries, whose dressing changes may be frequent and extensive.
Despite the evident impact of dressing-related pain on patients, healthcare providers sometimes fall short in effectively addressing this issue. Surveys of nursing practices have revealed gaps in pain assessment and management, with a substantial number of nurses failing to consistently evaluate or document pain levels during dressing changes. This disconnect between patient experience and clinical practice underscores the need for improved awareness and implementation of pain management strategies.
Traditional pharmacological approaches to pain management, while commonly utilized, come with their own set of challenges. High doses of opioid medications, such as morphine, pose risks of respiratory depression, nausea, and constipation, among other side effects. Moreover, even with pharmacotherapy, a significant proportion of patients continue to experience persistent pain, impacting their sleep, work, and social functioning.
In response to these challenges, there has been growing interest in non-pharmacological pain management techniques. Music therapy, for example, has shown promise in alleviating discomfort during dressing changes, offering patients an alternative means of pain relief and potentially reducing reliance on opioids. Non-pharmacological approaches are also endorsed by organizations like the American Society for Pain Management Nursing, which advocates for their integration into clinical practice to enhance patient outcomes and quality of life.
However, despite the increasing recognition of non-pharmacological therapies, there remains a need for comprehensive evidence-based guidance in this area. A thorough review of existing literature on non-pharmacological interventions for dressing-related pain can provide valuable insights for healthcare professionals, informing their decision-making and promoting more holistic approaches to wound care. By synthesizing the available evidence and highlighting effective strategies, such reviews can contribute to the development of standardized protocols and ultimately improve the management of pain in patients undergoing wound care dressing changes.
Method
The study adhered to the established reporting guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and was prospectively registered with PROSPERO. A systematic search of relevant literature pertaining to non-pharmacological interventions for wound care dressing pain was conducted across five major databases, covering the period from January 2010 to September 2022, following the PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria.
The search strategy encompassed a combination of subject terms and free words, with PubMed serving as an illustrative example of the comprehensive search process. Upon retrieval of relevant literature, a rigorous screening process was undertaken by two independent authors, who assessed the eligibility of studies based on predetermined inclusion and exclusion criteria. Duplicate literature was first identified and eliminated using appropriate software, followed by the exclusion of irrelevant studies based on title and abstract review. The final inclusion decision was made after a thorough examination of the full-text articles, with any discrepancies resolved through consensus among the authors, facilitated by a third researcher if necessary.
Quality assessment of the included literature was conducted independently by two reviewers, with discrepancies resolved through discussion or consultation with a third researcher until consensus was reached. The Cochrane Handbook for Reviews of Interventions was utilized to evaluate the risk of bias in the included studies, and Review Manager 5.3 software was employed to visualize the assessment results.
Data extraction and analysis were performed independently by two authors, who summarized key information such as author names, publication year and country, sample size, interventions, methodology, and study outcomes. The extracted data revealed a diverse range of wound care types, non-pharmacological interventions, and participant demographics, including children and the elderly. Additionally, variations in outcome assessment tools and limited comparability between interventions were noted. Consequently, a meta-analysis was deemed inappropriate for the review due to the heterogeneity of the included studies.
Inclusion Criteria
The study team meticulously constructed inclusion criteria following the PICOS framework, a systematic approach to defining research parameters. Population (P) encompassed all categories of wound care patients, while Intervention (I) focused on diverse non-pharmacological methods targeting pain management during wound care dressing changes. Comparison (C) was delineated as a control group receiving standard care by a daily nurse or no intervention at all. Outcomes (O) centered on evaluating patients’ pain levels as the primary metric for this review. Study type (S) was specifically limited to randomized controlled trials (RCTs), ensuring a rigorous and methodologically sound investigation into the efficacy of non-pharmacological interventions for alleviating pain during wound care. This meticulous delineation of criteria reflects the study team’s commitment to robust research methodology and the systematic evaluation of interventions in wound care settings.
Exclusion Criteria
The review establishes specific exclusion criteria to ensure the quality and relevance of the literature under consideration. These criteria include:
- Incomplete data: Studies lacking comprehensive data were excluded to uphold the integrity and reliability of the review’s findings.
- Non-English language literature: Limiting the review to English language literature ensures accessibility and facilitates thorough analysis.
- Non-RCTs with non-pharmaceutical interventions: Non-randomized controlled trials (RCTs) and studies involving non-pharmaceutical interventions such as quasi-experimental trials, case reports, and reviews were excluded to maintain focus on RCTs and pharmaceutical interventions.
- Quality rating of C: Literature with a quality rating of C, indicative of lower methodological rigor or higher risk of bias, was excluded to uphold the review’s standards of evidence quality and credibility.
By adhering to these exclusion standards, the review aims to maintain rigor, relevance, and reliability in synthesizing evidence pertaining to the topic of interest.
Result
The meta-analysis encompassed eleven Randomized Controlled Trials (RCTs) sourced from various nations, including Iran, China, Australia, Turkey, and the United States. In total, 951 individuals were involved, ranging from 5.5 years old to elderly outpatients averaging 67.69 years. The studies investigated pain management strategies across diverse wound types, such as burn wounds, abdominal surgical incisions, haemorrhoidectomy wounds, and chronic lower-limb wounds.
Quality assessment of the RCTs revealed a consistent rating of B, indicating overall moderate quality. Notably, measures to address selection bias, randomization methods, and reporting procedures were generally well-implemented. However, blinding issues were noted in some studies due to the nature of the interventions.
The review identified a variety of pain assessment tools utilized across the studies, including the Wong-Baker Faces Pain Rating Scale, Numerical Rating Scale, Faces Pain Scale-Revised, among others. The selection of assessment tools varied based on factors like patient demographics, cognitive abilities, and cultural backgrounds.
The interventions for wound care dressing change pain encompassed seven non-pharmacological therapies. These included auditory and visual distractions, hypnosis therapy, religious and spiritual care, foot reflexology, guided imagery, jaw relaxation, and Virtual Reality (VR) instrumentation distractions. Such interventions represent a diverse array of approaches aimed at alleviating pain and discomfort during wound care procedures.
Overall, the review highlights the importance of exploring non-pharmacological interventions for managing wound care dressing change pain and underscores the need for tailored approaches considering patient characteristics and preferences. Further research in this area could enhance our understanding and implementation of effective pain management strategies in clinical practice.
Conclusion
Pain management during wound care dressing changes has long been recognized as a crucial aspect of patient care, with pain being influenced by various physical, psychological, and social factors (Richardson, 2012). Extensive research has explored the relationship between pain and wound healing, highlighting the importance of effective pain management in promoting faster recovery (Ala et al., 2017; Goto & Saligan, 2020; J. H. Kim et al., 2020). Proper wound care is essential for facilitating healing (Tran et al., 2019), emphasizing the significance of managing wound care pain.
Given the multifaceted nature of pain, this review focuses on non-pharmacological interventions for pain during dressing changes, recognizing the limited availability of detailed literature on this specific aspect. To address this gap, a systematic evaluation within the framework of evidence-based medicine was initiated to contribute insights to practical clinical work.
The review identified 11 documents with a B quality rating, indicating some potential for bias in the studies. Despite efforts to maintain study quality, challenges in achieving complete blinding were acknowledged, particularly due to intervention limitations and the diverse range of wound types examined, including burns, abdominal surgical incisions, haemorrhoidectomy wounds, and chronic lower-limb wounds. The variability in subjective pain assessment methods further complicates the interpretation of intervention outcomes.
Meta-analysis was hindered by several factors, including the heterogeneity of wound types, non-pharmacological interventions, age groups, outcome indicators, and the limited number of interventions. Consequently, quantitative statistical techniques were somewhat constrained in deriving precise conclusions.
The review identified seven non-pharmacological therapies for pain during wound care dressing changes, with VR distraction, auditory and visual distractions, religious and spiritual care, foot reflexology, and guided imagery showing favorable significance. Each intervention is explored in detail, highlighting their potential efficacy in managing pain.
Implications for practice and future research underscore the importance of considering non-pharmacological interventions in pain management protocols. Challenges in implementing these interventions, including staff experience, patient acceptance, and resource availability, require careful consideration. Collaboration among multidisciplinary teams is crucial for formulating comprehensive pain management programs tailored to individual patient needs.
In conclusion, while evidence supports the hypothesis that non-pharmacological interventions can help alleviate pain during dressing changes, further research with larger sample sizes and multicentre trials is needed to confirm their effectiveness. Standardization of intervention implementation specifics is essential to ensure consistency and homogeneity across clinical settings.
Oncology Related Tools
Other
Latest Research
