Dressing-related pain in patients with chronic wounds: an international patient perspective

This cross-sectional international survey assessed patients’ perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68.6 years (SD = 15.4) participated. The wounds were categorised into ten different types with a mean wound duration of 19.6 months (SD = 51.8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n = 605). Frequency of wound-related pain was reported as 32.2%, ‘never’ or ‘rarely’, 31.1%, ‘quite often’ and 36.6%, ‘most’ or ‘all of the time’, with venous and arterial ulcers associated with more frequent pain (P = 0.002). All patients reported that ‘the wound itself’ was the most painful location (n = 1840). When asked if they experienced dressing-related pain, 286 (14.7%) replied ‘most of the time’ and 334 (17.2%) reported pain ‘all of the time’; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P , 0<001). Eight hundred and twelve (40.2%) patients reported that it took ,1 hour for the pain to subside after a dressing change, for 449 (22.2%) it took 1–2 hours, for 192 (9.5%) it took 3–5 hours and for 154 (7.6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0–100) giving a mean score of 44.5 (SD = 30.5, n = 1981). Of the 1141 who reported that they generally took pain relief,21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ‘pain’ was given the highest mean score of 3.1 (n = 1898). In terms of different types of daily activities, ‘overdoing things’ was associated with the highest mean score (mean = 2.6, n = 1916). During the stages of the dressing change procedure; ‘touching/handling the wound’ was given the highest mean score of 2.9, followed by cleansing and dressing removal (n = 1944). One thousand four hundred and eighty-five (80.15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58.15%) responded that they were concerned about the long-term side-effects of medication, 790 (40.3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail

Recent accomplishments in wound healing

The challenge to balance limited resources with infinite demand has encouraged an evolution in the way health care services are managed and operated. Chronic wound management is complex and prolonged, and places a considerable financial burden on health services. A typical driver of cost includes the necessity to change dressings on a regular basis. Over the last few decades, several scientific and biological advances have furthered the development of wound care products and facilitated wound management. This article investigates some of the major advancements that have occurred within the wound-care arena during the last 5 years and how these advancements are being translated to provide better delivery of clinical care to patients

Risk of diabetic foot ulceration: perception and behavioural change

Patients with diabetes must have an accurate understanding of their perceived risk of diabetic foot complications, although this alone does not demonstrate that preventive measures are being taken to avoid this risk. Various theories of health behaviour have been suggested to explain why people fail to engage in positive health behaviour. An understanding of where a patient might be in the process of behavioural change may enable the practitioner to select the intervention that might prove most effective for that patient

A focus group study into patients’ perception of chronic wound pain

Background: Dressing changes during the management of chronic wounds are often associated with pain, yet little qualitative research has been completed to gain an understanding of the impact of this on patients. Aims: This study aimed to involve patients in discussions about their wound pain in order to inform the development of a questionnaire based on their views. Methods: A purposeful sample of six participants with chronic venous ulceration was recruited to take part in a focus group discussion about pain. Free-flowing conversation was encouraged so that participants could discuss issues that were important to them. Results: The participants described two distinct types of pain — acute and constant. The impact of pain on everyday life led to isolation, loss of independence and sleep deprivation. The participants described a tendency towards habitual behaviour that led to a sense of vulnerability in the clinical environment. Cooling of the surrounding skin, having a support network and the use of medication were perceived to improve the experience. Conclusions: It is clear that living with a chronic wound has a huge impact on a person’s life. Healing is often a lengthy and uncomfortable process, yet the issue of patients’ perceptions of pain is still an area in which relatively little research has been conducted. Conflict of interest: This work is supported by an unrestricted educational grant from Mölnlycke Health Care

Living with venous leg ulceration: issues concerning adherence

Compression therapy is advocated for the treatment of chronic venous leg ulceration and the proportion of patients whose ulcers heal appears to be directly related to adherence (Moffatt, 2004). The aim of this study was to examine patients' understanding of adherence, in terms of their own experiences of compression bandage systems. Following full ethical approval, a purposeful sample of 6 participants was recruited to take part in a focus group. Free-flowing conversation was encouraged so that the participants could discuss issues that were important to them, although a series of prompts were available to stimulate the conversation when necessary. Four major themes were identified using a phenomenological approach: frustration with the healthcare system leading to a feeling of complacency with primary healthcare teams; functional limitations leading to adaptation of everyday life situations (e.g. bathing and coping with pain); emotional reactions affecting well-being and body image, and perception of others; and avoidance of transport, shopping and holidays

A qualitative approach to recovery after open tibial fracture: The road to a novel, patient-derived recovery scale

Aim The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach. Patients and methods Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery. Results Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental). Conclusion There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as ‘healed’ by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma