Assessment of ulcer and wound pain

See Assessing and managing wound-related pain for an overview of assessing wound-related pain.

There are many validated pain rating scales, including numerical, visual analogue, faces, verbal, and observational (for use when a patient has poor cognition or communication). See here for examples. Use the same scale at each assessment to monitor the patient's response to the pain management plan.

Table 1. Assessing and managing wound-related pain
1. Assess pain
history (timing, location, quality, triggers, relievers, severity, impact) examination (including observing patient's behaviour) review patient's pain diary if possible review response to therapy
2. Determine type of pain based on pain circumstances
Background pain Identify and manage causes of background pain: ischaemia (requires urgent referral) infection inflammation.	Incident pain (breakthrough pain caused by a specific activity) Precipitated by: movement contact pressure dressing movement while in situ elevating or lowering the limb.	Procedural pain Precipitated by: tape or dressing removal or application exposure of wound to air wound cleansing or handling debridement compression therapy.
3. Create management plan
Local management Consider: cleansing using a dressing that causes minimal pain on removal whether the patient would prefer to remove the dressing reducing frequency of dressing changes optimising moisture balance of wound managing oedema avoiding local pressure.	Systemic management Pharmacological therapy: analgesics adjuvant analgesics. Nonpharmacological therapy: exercise and physiotherapy psychological therapy social and environmental modification.	Procedures: prepare, plan, prevent pain Undertake the following: explain procedure and obtain consent involve patient in planning provide systemic analgesia 30 minutes before procedure use topical analgesia 30 to 40 minutes before procedure rate pain before, during and after procedure use a quiet, warm room; ensure patient is comfortable use warmed solutions minimise exposure time monitor patient's verbal, facial and body responses.