Practical treatment of pain in patients with chronic wounds: pathogenesis-guided management

• Published in: The American journal of surgery Vol. 188; no. 1; pp. 31 - 35
• Main Authors: Freedman, Gordon, Entero, Hyacinth, Brem, Harold
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2004; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Analgesics; Analgesics - therapeutic use; Anesthetics - therapeutic use; Anticonvulsants - therapeutic use; Antidepressants; Arterial Occlusive Diseases - complications; Autonomic Nerve Block; Chronic Disease; Diabetic Angiopathies - complications; Female; Health care; Humans; Male; Middle Aged; Pain - drug therapy; Pain - etiology; Pain management; Pain Measurement; Skin Ulcer - complications; Wound healing
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(03)00289-7

In addition to its own inherent morbidity, the pain associated with chronic wounds presents a primary obstacle to healing. To initiate safe and effective therapy, we used a multidisciplinary approach that required the wound-healing clinician and pain-management practitioner to work together to diagnose and treat the pain associated with these wounds. This approach emphasizes wound pathophysiology, which facilitates treatment modalities that focus on the cause of the pain as well as more efficient analgesia. All wound patients were approached with the assurance that they should not experience pain. The most important part of pain control is objective assessment and assuring patients that their pain will be resolved. Differential diagnosis is critical (eg, wound pain associated with infection, necrosis, spinal cord injury, neuropathy). We determined that to resolve pain, the following 4 goals must be achieved: (1) removal of all nonviable, locally infected tissue and elimination of all cellulitis; (2) determination of wound pathogenesis; (3) availability of both local and systemic analgesia; and (4) assessment of objective improvement through the periodic use of an analgesic scale. By following this protocol, the wound-healing clinician can expect decreased length of hospital stay and resolution of pain in nearly all patients with wounds.