Introduction

Assessing and managing wound-related pain is important—inadequately controlled pain delays wound healing and causes patient suffering. Assume the wound is painful (because wound pain is so common), unless the patient indicates otherwise. The risk of a wound being painful increases the longer it remains unhealed.

Nociceptive and neuropathic pain often coexist in wound-related pain. Nociceptive pain is caused by stimulation of peripheral pain receptors. Neuropathic pain is due to dysfunction within the nervous system, and is commonly described as burning, tingling, or like an electric shock.

Pain can develop in response to repeated painful stimuli (eg dressing changes). It may be triggered by light touch, exposure or air movement over a wound. On examination, altered sensation or allodynia (pain on light touch) may be detected.

The first step in pain management is to understand the nature of the pain and when it occurs. The most effective approach is multifactorial. This involves modifying precipitating and relieving factors, using analgesia, and addressing psychological and social factors. Communication and collaboration with the patient and others involved in their care, is important. Reassess and evaluate pain management strategies regularly, and adjust strategies accordingly.

Certain types of wound pain need specific management, such as inflammatory ulcers (eg vasculitic ulcer, pyoderma gangrenosum) and those that are clinically infected (see Ulcer and wound infection). Seek urgent opinion from a vascular specialist for ulcers on an ischaemic limb.