Assessment of wound pain: overview and a new initiative

Assessment of pain in chronic wounds: A survey of Australian health care practitioners

Pain associated with chronic wounds can delay wound healing, affects quality of life, and has a major impact on physical, emotional, and cognitive function. However, wound-related pain is often under-assessed and may therefore be suboptimally managed. The aim of this study was to describe the assessment practices used to assess chronic wound pain by health practitioners in Australia. A structured self-administered questionnaire was posted to members of an Australian national wound care organisation, whose membership represents various health practitioners involved in wound management. A total of 1190 (53%) members completed the survey. Overall, wound pain assessment was most commonly conducted at every consultation or wound dressing change (n = 718/1173, 61%). Nurses were more likely to assess wound-related pain before, during, and after the wound dressing procedures compared with other health care practitioners. In contrast, podiatrists assessed wound pain only when the patient complained about the pain. The most common assessment method was simply talking to the patient (n = 1005/1180, 85%). Two-thirds of practitioners used a validated pain assessment tool. The most commonly used tool was the numerical analogue scale (n = 524/1175, 46%). In summary, these findings suggest that there is no consistent method for the assessment of wound-related pain, and there are substantial variations in how and when wound-related pain is assessed between different professions.

Comparison of bupivacaine and bupivacaine plus magnesium sulphate infiltration for postoperative analgesia in patients undergoing lumbar laminectomy: A prospective randomised double-blinded controlled study

Background: Laminectomy is associated with considerable postoperative pain. Providing analgesia locally in the area of surgical trauma, with minimal systemic side effects, is an attractive option and has become an integral part of multimodal analgesia. The objective of this study was to assess and compare the effectiveness and safety of local infiltration of bupivacaine and bupivacaine plus magnesium sulphate for postoperative analgesia in patients undergoing lumbar laminectomy. Materials and Methods: Sixty adult patients of the American Society of Anaesthesiologists (ASA) class 1 and 2 were randomly allocated into two groups, comprising 30 patients in each group. After the completion of lumbar laminectomy, the study drug was locally infiltrated into the paravertebral muscles on either side. Group bupivacaine with magnesium (BM) was given 20 ml of 0.25% bupivacaine with 500 mg of magnesium sulphate (constituted with normal saline); and Group bupivacaine (B) was given 20 ml of 0.25% bupivacaine constituted with normal saline. Postoperative visual analogue scale (VAS) pain scores at 1, 2, 4, 6, 8, 12 and 24 hours; rescue analgesia, the time to first analgesic consumption, degree of overall patient satisfaction and side effects were recorded. Comparison of continuous data between groups was done using independent T-test. Comparison of nominal data was done using Chi-square analysis and ordinal data using Mann-Whitney test. A P value less than 0.05 was considered significant. Results: Time to first analgesic consumption was significantly longer in BM group (7.78 ± 1.350 hours) compared to B group (4.62 ± 0.997 hours) (P < 0.0001). The consumption of Tramadol was significantly higher in B group (202.5 ± 76.9 mg) compared to BM (117.5 ± 63.4 mg) (P < 0.0001). The degree of overall satisfaction with postoperative pain management on a 4-point satisfaction scale was better in BM group (2.77 ± 0.626) compared to B group (2.0 ± 0.587) (P < 0.001). Conclusion: Wound infiltration with bupivacaine and magnesium sulphate provided better pain control and analgesic effect was more significant, providing effective and safe postoperative analgesia in patients undergoing laminectomy surgeries.

Effects of different floor housing systems on the welfare of fast-growing broilers with an extended fattening period

Abstract. This study was made to investigate the long-term effects of different floor housing systems on the welfare of fast-growing broilers. The experiment was performed on 210-day-old fast-growing hybrid male chickens with identical conditions until 47 days of age. Animal-based welfare parameters were measured to investigate the welfare level in the group housed on deep litter, a litter and slat system, and a slatted floor, with five replicates for each group. Results showed that the main welfare indicators in live birds, such breast dirtiness, plumage score, footpad lesion, and hock burn lesion, were negatively affected in broilers kept on conventional deep-litter floor housing. But hemorrhage or lesion scores of the breast and shoulder of broilers in slat floor housing were found to be significantly greater than in conventional deep litter as a result of a heavy body weight at a greater slaughter age (p<0.05). Pathologically, the prevalence of footpad and hock joint dermatitis was very high in the deep-litter housing system. Femoral head necrosis was not observed in any floor housing group. The results indicated that keeping broilers on a slat flooring system is preferable for younger slaughter ages and for a lighter slaughter weight. When considering the relationship between animal welfare and production economy, moving from one floor house system to another floor housing system should be carefully weighted in future decisions. Moreover, further investigations are needed in order to examine the incidence of joint and bone problems with muscle inflammation in heavier broilers in commercial conditions.

Wound assessment tools and nurses' needs: an evaluation study

The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose. The methodology employed was evaluation research. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses' needs. Several freely available wound assessment tools were selected based on predetermined inclusion and exclusion criteria and an audit tool was developed to evaluate the selected tools based on how well they met the criteria of the optimal wound assessment tool. The results provide a measure of how well the selected wound assessment tools meet the criteria of the optimal wound assessment tool. No tool was identified which fulfilled all the criteria, but two (the Applied Wound Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses' needs in wound assessment. The study provides a mechanism for the appraisal of wound assessment tools using a set of optimal criteria which could aid practitioners in their search for the best wound assessment tool.

Histologically-validated footpad dermatitis scoring system for use in chicken processing plants

1. Footpad dermatitis (FPD) is a recognised welfare problem in broiler chickens. Broiler feet (n = 54) were examined macroscopically and microscopically to determine a reliable correspondence between macroscopic and histological features, and to devise a scoring system that was relevant to bird welfare and easy to use at processing plants. 2. Three types of footpad lesion were defined based on their severity. Type I were mild lesions, visually characterised by scale enlargement and erythema, and histologically by hyperplasia and hyperkeratosis of the epidermis, superficial dermal congestion and oedema. Type II were moderate, superficial lesions, visually characterised by hypertrophic and hyperkeratotic scales covered with yellowish to brownish exudate, and histologically by a prominent pustular and crust-forming dermatitis. Type III lesions were the most pronounced, visually characterised by a thick dark adherent crust, and histologically by extensive ulceration. 3. On the basis of the severity and extent of these three types of lesions, a 5-point scale was devised, i.e. no or type I lesion (score 1), type II lesion (<50% or >50% of footpad, scores 2 and 3 respectively) and type III lesion (<50% or >50% of footpad, scores 4 and 5 respectively). 4. The scoring system has the advantage of making sense in terms of welfare compared with previous schemes. Furthermore, it is histologically validated and easy to use for the routine assessment of broiler welfare in processing plants.

Practical aspects of postoperative analgesia

The article summarizes the experience of the use of narcotic, non-narcotic and adjuvant drugs for postoperative analgesia. Most basic algorithms of postoperative pain relief available in a hospital are considered in complex post-operative intensive care in surgical clinic. Application of the recommended scheme is likely to prevent nosocomial narcotism in patients with prolonged pain.

Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence

Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous leg ulcers (VLUs) (ie, ulcers with a surface area ≥10 cm² and duration of ≥6 months) showed that the application of amelogenin (Xelma^®, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.

Minimising wound-related pain at dressing change: evidence-informed practice

Pain is a common concern in patients with chronic wounds. The purpose of this article is to inform clinicians of empirical evidence for practice based on a recent published consensus document on wound related pain. A team approach is needed to address the experience of living with wound related pain within a holistic framework. The importance of regular pain assessment and strategies to minimize traumatic during wound care are highlighted.

'Heal not hurt': piloting an initiative on wound pain assessment

As a number of consensus and position documents have made clear, wound pain is an issue that all nurses involved in wound care should take seriously. Based on the 'Heal not hurt' initiative supported by MoInlycke, a wound assessment tool has been adopted by East Riding of Yorkshire PCT. This article gives an overview of the documentation and argues that thorough assessment is essential in wound care and proper documentation is the key to successful clinical outcomes.