Painful wounds in palliative care
Systemic analgesics may be required to manage pain associated with wounds, but they are often only partially effective.
Although evidence is limited, topical analgesics (eg morphine, lidocaine) can be useful to manage painful wounds, either instead of (or in addition to) systemic opioid therapyJohnson, 2017LeBon, 2009. Potential adverse effects of topical analgesics include systemic absorption and maceration of the wound, so they should only be used if wound healing is not possible and comfort and pain management are a priority. Formulations include morphine gel1, parenteral morphine applied directly to the wound, and lidocaine gel.
If a dressing change is likely to be painful or distressing, give adequate systemic analgesic therapy, allowing enough time for peak analgesia to be achieved before starting dressing. In some cases, an anxiolytic may also be required; see Incident pain in palliative care patients.
If a wound remains painful despite appropriate analgesic therapy and wound care, assess for evidence of infection. Pain may improve if infection is appropriately treated with antibiotics; see Ulcer and wound infection in the Ulcer and Wound Management guidelines.