The importance of pain reduction through dressing selection in routine wound management: the MAPP study

Targeting Diverse Wounds and Scars: Recent Innovative Bio-design of Microneedle Patch for Comprehensive Management

Wounds and the subsequent formation of scars constitute a unified and complex phased process. Effective treatment is crucial; however, the diverse therapeutic approaches for different wounds and scars, as well as varying treatment needs at different stages, present significant challenges in selecting appropriate interventions. Microneedle patch (MNP), as a novel minimally invasive transdermal drug delivery system, has the potential for integrated and programmed treatment of various diseases and has shown promising applications in different types of wounds and scars. In this comprehensive review, the latest applications and biotechnological innovations of MNPs in these fields are thoroughly explored, summarizing their powerful abilities to accelerate healing, inhibit scar formation, and manage related symptoms. Moreover, potential applications in various scenarios are discussed. Additionally, the side effects, manufacturing processes, and material selection to explore the clinical translational potential are investigated. This groundwork can provide a theoretical basis and serve as a catalyst for future innovations in the pursuit of favorable therapeutic options for skin tissue regeneration.

Chronic wound-related pain, wound healing and the therapeutic potential of cannabinoids and endocannabinoid system modulation

Chronic wounds represent a significant burden on the individual, and the healthcare system. Individuals with chronic wounds report pain to be the most challenging aspect of living with a chronic wound, with current therapeutic options deemed insufficient. The cutaneous endocannabinoid system is an important regulator of skin homeostasis, with evidence of system dysregulation in several cutaneous disorders. Herein, we describe the cutaneous endocannabinoid system, chronic wound-related pain, and comorbidities, and review preclinical and clinical evidence investigating endocannabinoid system modulation for wound-related pain and wound healing. Based on the current literature, there is some evidence to suggest efficacy of endocannabinoid system modulation for promotion of wound healing, attenuation of cutaneous disorder-related inflammation, and for the management of chronic wound-related pain. However, there is 1) a paucity of preclinical studies using validated models, specific for the study of chronic wound-related pain and 2) a lack of randomised control trials and strong clinical evidence relating to endocannabinoid system modulation for wound-related pain. In conclusion, while there is some limited evidence of benefit of endocannabinoid system modulation in wound healing and wound-related pain management, further research is required to better realise the potential of targeting the endocannabinoid system for these therapeutic applications.

Pain Management in Dermatology

BACKGROUND

The dermatologist has to deal with many situations where the patient feels pain and must therefore know how to manage it.

SUMMARY

The aim of this review was to explore the treatments available to manage pain in dermatology in different circumstances, with an emphasis on pharmacological and non-pharmacological interventions specifically studied in dermatology.

Pain Management in Older Adults with Chronic Wounds

Older people often suffer from different types of ulcers, with the most prevalent being chronic leg ulcers (CLUs) and diabetic foot ulcers. There are major issues in the current medical approach because these ulcers are hard to heal, and, in the case of CLUs, very painful and with a high frequency of relapse. Older people complain of pain more frequently than young people, frequently due to a combination of painful chronic wounds with other comorbidities (e.g. arthritis, peripheral arterial disease, vertebrogenic pain syndrome). However, chronic pain appears to be managed better by older people because the pain sensitivity is downregulated and the pain threshold is higher in older people. Pain management of chronic wounds is often insufficient, especially in older individuals. It is highly important to use non-traumatic wound dressings and pay attention to patients' feelings and fears because pain in chronic ulcers can impair wound healing. Key factors include good preparation for dressing change and adequate analgesia, ideally a combination of topical and oral agents.

Dermatological Conditions Inducing Acute and Chronic Pain

Pain is a common condition in dermatology. The aim of this review is to analyse the characteristics of pain in dermatology. Some skin diseases are conventionally known to cause pain; e.g. ulcers, pyoderma gangrenosum and herpes zoster. Common dermatoses, such as psoriasis or atopic dermatitis, can also cause significant pain. Some conditions are characterized by neuropathic pain and/or pruritus, without visible primary lesions: e.g. the neurocutaneous diseases, including small fibre neuropathies. Patients often fear pain in skin surgery; however, surgical procedures are rather well tolerated and any pain is mainly due to administration of local anaesthetic. Some therapies may also be uncomfortable for the patient, such as photodynamic therapy or aesthetic procedures. Thus, pain in dermatology is common, and its aetiology and characteristics are very varied. Knowledge of the different situations that cause pain will enable dermatologists to propose suitable analgesic solutions.

Severity of Wound-Related Pain and Associated Factors Among Patients Who Underwent Wound Management at Teaching and Referral Hospital, Northwest Ethiopia

Background

Wound management is one of the commonly performed procedures in hospitals. It can be a major source of pain and pain may be a frequently experienced but under-considered component of wound management. Therefore, we aimed to determine the severity of wound-related pain and identifying factors associated with it among patients who underwent wound management.

Patients and Methods

An institutional-based, cross-sectional study was conducted from March to May, 2020 in the University of Gondar Comprehensive Specialized Hospital. A total of 424 patients were included in this study. Data were collected by direct observation, chart review, and interview of patients by using questionnaires. Statistical analysis had performed using SPSS 25.00 version statistical software. Descriptive statistics were conducted to summarize patients’ information and to determine the prevalence of pain. Bi-variable analysis was performed to determine each of the independent variables and only variables with a P-value<0.2 were entered into the multivariable analysis. The strength of the association was present by odds ratio and 95% Confidence interval. P-value<0.05 was consider as statistically significant.

Results

The prevalence of moderate-to-severe wound-related pain during wound management was 94.1% (95% CI=91.7–96.2). Anxiety (AOR=18.16; 95% CI=4.83–68.23), acute wound (AOR=11.49; 95% CI=1.013–130.2), baseline pain (AOR=3.51; 95% CI=1.18–10.46), and analgesia intake (AOR=0.026; 95% CI=0.001–0.895) were significantly associated with the severity of wound-related pain.

Conclusion

The prevalence of moderate-to-severe wound-related pain was considerably high. Anxiety, type of wound, baseline pain, and analgesia intake were the independent risk factors. Therefore, wound care providers should assess the severity of wound-related pain and manage accordingly. Additionally, more emphasis should be given for patients who have baseline pain, anxiety, and acute wound.

Influence of delayed umbilical cord clamping on pain during suture of perineal tears: A randomised controlled study

OBJECTIVE

This study investigated whether the delayed umbilical cord clamping can influence the pain during suturing perineal tears.

DESIGN

This randomised controlled study applied the Consolidated Standards of Reporting Trials statement.

METHODS

The sample comprised 288 pregnant women who gave birth through vaginal delivery in our hospital from November 2019 to December 2019. They were randomly divided into 2 groups-early umbilical cord clamping (n = 147) and delayed umbilical cord clamping (n = 141)-without severe pregnancy complications. There was no intrauterine infection, neonatal asphyxia or premature birth in the 288 newborns. The pain scores of the Numerical Rating Scale, Visual Analogue Scale, Verbal Rating Scale and Faces Pain Scale-Revised were used as indicators to evaluate the mothers' pain. The Mann-Whitney U test was used, and the statistical significance was set to p < .05.

RESULT

All indicators suggest that perineal suture pain of delayed umbilical cord clamping was lower than that of the control group. For the experience group, the perception of pain for the mothers who received analgesia was less than that for those who did not. For the control group, the Verbal Rating Scale suggests a statistical difference in suturing pain between acceptable and unacceptable labour analgesia. The degree of cooperation of the experience group was higher than that of the control group, but labour analgesia did not affect cooperation degree in both groups.

CONCLUSION

Delayed umbilical cord clamping can alleviate maternal pain when suturing perineal tears and improve the delivery experience. Labour analgesia can enhance the pain relief effect. Trial registration was performed on www.chictr.org.cn (ChiCTR1900026797).

RELEVANCE TO CLINICAL PRACTICE

As a part of perinatal nursing, delayed umbilical cord clamping can help alleviate the pain of perineal suture and improve the experience of parturient. The method is simple and can be used as a routine nursing operation.

Design Considerations for Hydrogel Wound Dressings: Strategic and Molecular Advances

Wound dressings are traditionally used to protect a wound and to facilitate healing. Currently, their function is expanding. There is an urgent need for new smart products that not only act as a protective barrier but also actively support the wound healing process. Hydrogel dressings are an example of such innovative products and typically facilitate wound healing by providing a hospitable and moist environment in which cells can thrive, while the wound can still breathe and exudate can be drained. These dressings also tend to be less painful or have a soothing effect and allow for additional drug delivery. In this review, various strategic and molecular design considerations are discussed that are relevant for developing a hydrogel into a wound dressing product. These considerations vary from material choice to ease of use and determine the dressing's final properties, application potential, and benefits for the patient. The focus of this review lies on identifying and explaining key aspects of hydrogel wound dressings and their relevance in the different phases of wound repair. Molecular targets of wound healing are discussed that are relevant when tailoring hydrogels toward specific wound healing scenarios. In addition, the potential of hydrogels is reviewed as medicine advances from a repair-based wound healing approach toward a regenerative-based one. Hydrogels can play a key role in the transition toward personal wound care and facilitating regenerative medicine strategies by acting as a scaffold for (stem) cells and carrier/source of bioactive molecules and/or drugs. Impact statement Improved wound healing will lead to a better quality of life around the globe. It can be expected that this coincides with a reduction in health care spending, as the duration of treatment decreases. To achieve this, new and modern wound care products are desired that both facilitate healing and improve comfort and outcome for the patient. It is proposed that hydrogel wound dressings can play a pivotal role in improving wound care, and to that end, this review aims to summarize the various design considerations that can be made to optimize hydrogels for the purpose of a wound dressing.

Impregnated acetate gauze compared with lipido-colloid contact layer at dressing removal pain: a single-blind cross-over randomised control trial

OBJECTIVE

To evaluate the performance of Jelonet Plus (JP) and UrgoTul (UT), assessing pain at dressing removal when managing acute or chronic wounds at granulation and epithelialisation stages.

METHODS

This was a randomised, multicentre, controlled single-blinded study using a cross-over design. Hospitalised and ambulatory patients presenting with non-infected acute or chronic wounds (at least 40% of wound area of ≤100cm² covered with granulation tissue) were randomly allocated to be treated with either JP or UT dressings applied according to a standardised local care procedure for two days. At the following visit, patients received the other dressing for a second 2-day period. Pain was evaluated after two days of dressing application and immediately after its removal using a 100mm Visual Analog Scale (VAS). A pain level >30mm was considered as clinically relevant. A lower limit of -12% was determined as the threshold necessary to demonstrate the non-inferiority of JP compared to UT.

RESULTS

For the 99 patients completing the study, a difference of 7.9% was observed in favour of JP (83.8% JP versus 75.9% UT) for pain immediately after dressing removal (VAS score < 30mm) with a confidence interval (CI) lower limit of -2.6%, demonstrating non-inferiority (pre-defined limit of -12%). Concerning pain at dressing removal, a difference of 19.6% was observed in favour of JP (81.6% versus 62.0%; p=0.029 for superiority analysis), with a CI lower limit ranging from 2.4% to 38.9%. Therefore, superiority could be concluded. A statistically significant period effect was detected (p=0.003) with fewer patients experiencing pain after the second period day 2 (D2) to day 4 (D4) than the first day 0 (D0) to D2. A statistically significant cross-over effect was also detected (p=0.047), with fewer patients experiencing pain when JP was applied first followed by UT. This suggests a carry-over effect thus preventing a full cross-over design analysis. Adherence of the dressing was less frequent with the JP than the UT dressing (2.0% JP versus 6.9% with UT).

CONCLUSION

Non-inferiority of pain at dressing removal was demonstrated with JP. Superiority on this criteria was non-significant but we found adherence of the dressing to the wound bed to be more rare.

Developing in vitro assays to quantitatively evaluate the interactions of dressings with wounds

Evaluating interactions between dressing and wound is important for understanding wound management. This study quantitatively compared four polyurethane foam-based wound dressings for their absorption profile, cell penetration, and adherence using two novel in vitro assays. The dressing with uniform pore sizes varying from 25~75 μm showed the highest absorption of both culture media and serum. The same dressing showed a 1.2- to 3.6-fold lower cell adherence (3 hours) than the other dressings, and ~20-fold lower cell penetration (5 days) than dressings with pore sizes varying from 55 to 343 μm. Additionally, cell and dressing interactions using a 3-dimensional wound healing assay showed that the dressings with the smallest pore size of 25~75 μm maintained the highest cell viability (76.3%) and promoted cell migration into the wound site. This data suggest that polyurethane foam dressing with smaller and evenly distributed pores promotes wound healing with less cellular adhesion and penetration.

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.

Severe pain during wound care procedures: A cross-sectional study protocol

AIM

The aim of this study is to: (a) develop and evaluate a model to predict severe pain during wound care procedures (WCPs) so that high-risk patients can be targeted for specialized dressings and preventive pain control; and (b) identify biological factors associated with severe pain during WCPs so that novel pain control strategies can be developed.

BACKGROUND

Wound care procedures such as dressing changes can cause moderate to severe pain in 74% of patients, with nearly half (36%) of all patients experiencing severe pain (rated as 8-10 on a 10-point numeric rating scale) during dressing change. Additionally, clinicians have little direction with current guidelines regarding pain control during WCPs including the selection of the appropriate advanced wound dressings and the appropriate use of analgesics.

DESIGN

This is a cross-sectional study.

METHODS

The National Institute of Nursing Research approved and funded the study June of 2015 and the appropriate Institutional Review Board approved all study protocols prior to funding. Study enrolment is underway at the University of Iowa Hospitals and Clinics with a target of 525 participants. Potential participants must be adults (21+ years) and have a nonburn, nondiabetic foot, full-thickness wound. The research team performs a one-time study dressing change on enrolled participants and collects all study data.

DISCUSSION

This study will allow the development of a tool for clinicians to use to predict severe pain during WCPs and identify biological factors significantly associated with severe pain during WCPs.

A randomised, controlled, non-inferiority trial comparing the performance of a soft silicone-coated wound contact layer (Mepitel One) with a lipidocolloid wound contact layer (UrgoTul) in the treatment of acute wounds

Wound contact layer (WCL) dressings are intended to protect tissue during the healing process. A randomised controlled trial was undertaken to compare 2 such dressings. Outpatients with acute wounds were randomly allocated to treatment with either a soft silicone-coated WCL (intervention group, n = 59) or a lipidocolloid-impregnated WCL (control group, n = 62). At the first dressing removal (day 3), 89.8% of patients in the intervention group experienced non-painful dressing removal (defined as a pain rating <30 mm on a 100 mm visual analogue scale), compared with 73.6% of patients in the control group (P = .017) (per protocol population). At day 21, wounds were considered as healed in 66.1% of patients in the intervention group compared with 43.5% in the control group (P = .012) (intention-to-treat population). Both dressings were well tolerated and rated highly in terms of in-use characteristics, although the soft silicone-coated WCL was rated significantly higher than the lipidocolloid-impregnated WCL in terms of its ability to remain in place (P= .016). The results indicate that the soft silicone-coated WCL is suitable for the management of acute wounds as it can minimise dressing-associated pain and support healing.

UrgoClean Ag: evidence base and mode of action

UrgoClean Ag is indicated for all exuding wounds with signs of increased bioburden and biofilm. This article describes the evidence base supporting its efficacy.

Factors associated with high pain intensity during wound care procedures: A model

The most common wound care procedures (WPCs) performed on open wounds are dressing changes and wound cleansing. Dressing changes cause moderate to severe pain in 74% of patients, nearly half (36%) of whom experience severe pain (rated as 8-10 on a 10-point numeric rating scale). The purpose of this paper is to propose a model of clinically accessible factors that can be tested in order to develop a clinical tool to identify which patients are likely to experience high intensity pain during nonoperative WCPs, such as dressing changes. Although multiple factors are known to be associated with pain, the factors selected for this model were limited to those that (1) are supported based on evidence and/or pain mechanisms and (2) are readily accessible to clinicians/practitioners and can be tested as a prediction tool to be used prior to WCPs. This model may be helpful to identify those likely to experience high intensity pain during WCPs. In this way, use of aggressive pain management strategies, including specialty dressings, pharmacologic analgesics, and/or non-pharmacological strategies, such as high intensity transcutaneous electrical stimulation.

Patient-specific 3D scanned and 3D printed antimicrobial polycaprolactone wound dressings

The increasing prevalence of wound infections caused by antibiotic resistant bacteria is an urgent challenge facing modern medicine. To address this issue the expedient use of antimicrobial metals such as zinc, copper and silver were incorporated into an FDA-approved polymer (polycaprolactone - PCL) to produce filaments for 3D printing. These metals have broad-spectrum antimicrobial properties, and moreover, copper and zinc can enhance the wound healing process. 3D scanning was used to construct 3D models of a nose and ear to provide the opportunity to customize shape and size of a wound dressing to an individual patient. Hot melt extrusion was used to extrude pellets obtained by vacuum-drying of solutions of PCL and the different metals in order to manufacture metal-homogeneously-loaded filaments. Wound dressings with different shapes were produced with the filaments containing different concentrations of metals. Release of the metals from the dressings was determined by inductively coupled plasma atomic emission spectroscopy. All the different metal dressings show fast release (up to 24h) followed by slow release (up to 72h). The antibacterial efficacy of the wound dressings was tested using a thermal activity monitor system, revealing that silver and copper wound dressings had the most potent bactericidal properties. This study shows that 3D scanning and 3D printing, which are becoming simpler and more affordable, have the potential to offer solutions to produce personalised wound dressings.

Ibuprofen loaded PVA/chitosan membranes: A highly efficient strategy towards an improved skin wound healing

During wound healing, an early inflammation can cause an increase of the wound size and the healing process can be considerably belated if a disproportionate inflammatory response occurs. (S)-ibuprofen (IBP), a non-steroidal anti-inflammatory agent, has been used for muscle healing and to treat venous leg ulcers, but its effect in skin wound healing has not been thoroughly studied thus far. Herein, IBP-β-cyclodextrins carriers were designed to customise the release profile of IBP from poly(vinyl alcohol)/chitosan (PVA/CS) dressings in order to promote a faster skin regeneration. The dressings were produced using supercritical carbon dioxide (scCO₂)-assisted technique. In vitro IBP release studies showed that β-cyclodextrins allowed a controlled drug release from the hydrogels which is crucial for their application in wound management. Moreover, the in vivo assays revealed that the presence of PVA/CS membranes containing IBP-β-cyclodextrins carriers avoided scab formation and an excessive inflammation, enabling an earlier skin healing.

UrgoClean: the evidence base

This chapter describes a dressing, UrgoClean, which can rapidly and effectively reduce wound slough and absorb excess exudate. There is strong evidence to support this, including a randomized controlled trial.

New Twist on an Old Favorite: Gentian Violet and Methylene Blue Antibacterial Foams

Significance: Absorptive antibacterial dressings that assist in controlling bioburden without risks of cytotoxicity or residual absorption can be effectively used for prolonged periods throughout the wound healing continuum. Recent Advances: Until recently, gentian violet and methylene blue (GV/MB) antibacterial dressings have been commercially available only in polyvinyl alcohol (PVA) foam; polyurethane (PU) foam bonded with GV and MB with thin film backing is now commercially available. GV/MB PU foam does not require hydration or a necessary secondary dressing. GV/MB PVA and PU foam dressings were recently granted FDA clearance as antibacterial dressings, as opposed to bacteriostatic dressings as previously classified. Within the class of antibacterial dressings, GV/MB foam dressings are of lower cost alternative to silver- or iodine-based antibacterial dressings with no risk of absorption of any of the foam components into the tissues. Critical Issues: Control of wound bioburden levels by antibacterial agents and absorption of excess exudate are crucial in preventing infections that drastically increase the price of wound care. Use of GV/MB dressings may improve wound healing outcomes and decrease overall costs through super absorption, promotion of autolytic debridement, bioburden reduction, ease of use, and decreased dressing change frequency. Future Directions: Evolution in resistant bacterial strains will drive continual changes in advanced wound care products. Demand will increase for economically priced, versatile wound care dressings that assist in debridement, maintain a moist wound environment, absorb and trap bacterial debris, and decrease dressing change frequency.

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery

PURPOSE

The peritoneum is the serous membrane that covers the abdominal cavity and most of the intra-abdominal organs. It is a very delicate layer highly susceptible to damage and it is not designed to cope with variable conditions such as the dry and cold carbon dioxide (CO2) during laparoscopic surgery. The aim of this review was to evaluate the effects caused by insufflating dry and cold gas into the abdominal cavity after laparoscopic surgery.

METHODS

A literature search using the Pubmed was carried out. Articles identified focused on the key issues of laparoscopy, peritoneum, morphology, pneumoperitoneum, humidity, body temperature, pain, recovery time, post-operative adhesions and lens fogging.

RESULTS

Insufflating dry and cold CO2 into the abdomen causes peritoneal damage, post-operative pain, hypothermia and post-operative adhesions. Using humidified and warm gas prevents pain after surgery. With regard to hypothermia due to desiccation, it can be fully prevented using humidified and warm gas. Results relating to the patient recovery are still controversial.

CONCLUSIONS

The use of humidified and warm insufflation gas offers a significant clinical benefit to the patient, creating a more physiologic peritoneal environment and reducing the post-operative pain and hypothermia. In animal models, although humidified and warm gas reduces post-operative adhesions, humidified gas at 32 °C reduced them even more. It is clear that humidified gas should be used during laparoscopic surgery; however, a question remains unanswered: to achieve even greater clinical benefit to the patient, at what temperature should the humidified gas be when insufflated into the abdomen? More clinical trials should be performed to resolve this query.

Comparison of lipidocolloid and chlorhexidine-impregnated tulle gras dressings following microscopically controlled surgery

OBJECTIVE

Modified microscopically controlled surgery (MCS) is a staged and margin-controlled excision; after MCS, the selection of an appropriate initial wound dressing plays an important role in wound healing. A wide range of dressings is available for temporary wound coverage; however, data comparing different types of wound dressings after MCS are lacking. The aim of this study was to compare two commonly used and commercially available types of wound dressings.

METHOD

We assessed pain levels, wound adherence, bleeding upon dressing removal and signs of infection, with chlorhexidine-impregnated tulle gras and a lipidocolloid dressing used for primary wound dressing following MCS.

RESULTS

A total of 42 patients were included. Adherence of the dressing to the wound (p<0.001) and bleeding after removal (p=0.001) were significantly higher in the chlorhexidine-impregnated tulle gras dressing group. Pain during removal of wound dressing had a higher visual analogue scale score (1.9 ± 2.2) in the chlorhexidine-impregnated tulle gras dressing group compared to 0.7 ± 1.0 in the lipidocolloid dressing group (p=0.022).

CONCLUSION

The results indicate that the lipidocolloid dressing, when compared with the chlorhexidine-impregnated tulle gras dressing, offers a significant benefit during removal in terms of less pain, less wound adherence and less wound bleeding.

DECLARATION OF INTEREST

The authors have no conflict of interest to declare.

The thickness of exudate: does it matter?

The majority of chronic wounds are managed in the community by the district nursing team. With increasing constraints on the health-care budget, it can be tempting to manage exudate by focusing solely on the exudate-handling capability of some of the more absorbent dressings available. However, exudate levels and viscosity can change depending on the patient and the wound, with exudate being a marker of potential infection. Ongoing assessment of the wound, the exudate and the patient is pivotal to effective wound management, with timely and appropriate intervention being key. This article discusses this management, with particular focus on dealing with thick exudate.

Wound pain

In acute and chronic wounds, pain represents a common and central medical problem. Wound pain can be caused by multiple factors, such as macro- or microvascular as well as inflammatory processes.

The basic concept of pain management is based on the WHO pain ladder. Often this concept of pain therapy remains insufficient. Apart from the conventionally used anal-getics, there are not yet established guidelines for the use of alternative substances.Ultimately the adequate wound pain therapy must be adjusted to each patient and his comorbidities.

Assessment of patients' wound-related pain experiences in University College Hospital, Ibadan, Nigeria

This study was necessitated by the international recognition of wound-related pain (WRP) as a must-address issue and patient-centred concerns. The aim of this study was to assess patients' WRP experiences at rest and in relation to dressing change. This descriptive study utilised a WRP questionnaire which incorporated a visual analogue scale of 0-10 for data collection. A total of 109 patients participated in this study; 95·4% of the participants experienced wound pain at rest and during performance of activities of daily living, which were moderate (47·1%) and severe (30·8%) in intensity. Also, 91·7% of the participants experienced wound dressing change-related pain, mostly as moderate (47·0%) and severe (28·0%) pain. The major factors that worsened WRP experiences were touch/handling, change in position/movement, wound cleansing, removal of dressings and usage of honey as a dressing agent, while the use of analgesic and brief rest between dressing change were considered the major strategies that can relieve WRP. WRP experiences have been reported by patients at rest, during performance of activities of daily living and at wound dressing change. A need to incorporate WRP assessment has been observed, which is vital in improving wound care outcome.

The effect of Burns & Wounds (B&W)/burdock leaf therapy on burn-injured Amish patients: a pilot study measuring pain levels, infection rates, and healing times

PURPOSE

The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock (Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh.

DESIGN

A prospective, case series design guided the study within a community-based participatory research framework.

METHODS

Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed.

RESULTS

Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days.

CONCLUSION AND IMPLICATIONS

The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible.

An evaluation of KerraMax Care in the management of moderate to heavily exuding wounds

Highly exuding wounds are common and can result in malodour, pain, maceration, infection and unsightly soiled dressings, as well as having a negative impact on an individual's quality of life. This communication reports on the findings from an evaluation by nurses regarding the clinical effectiveness and safety of superabsorbent dressing KerraMax Care and the patient experience of KerraMax Care in the management of moderate to highly exuding wounds. A total of 54 evaluations were completed. Nurses commented on the main benefits seen clinically with KerraMax Care as being reduced maceration, exudate managed and improved wound appearance. Other changes observed in wound appearance noted were visible granulation tissue and reduced pain. The evaluation demonstrates the positive impact that good dressing selection can have on the lives of patients, improving their wound-care experience and outcome.

Cavity wounds management: a multicentre pilot study

The objective of this study was to assess acceptability (based on pain at removal), efficacy and tolerance of an absorbent and cohesive rope(UrgoClean Rope, Laboratoires Urgo) in the local management of deep cavity wounds. This study was a prospective, multicentre (13), non comparative clinical study. Patients presenting with an acute or chronic non-infected cavity wound were followed up for four weeks and assessed weekly with a physical examination, in addition to volumetric,planimetric and photographic evaluations. Pain at removal was the primary criterion, assessed on a Visual Analogic Scale. The percentage of the wound surface area reduction and volumetric reduction were considered as secondary efficacy criteria. Forty three patients were included in this study. After one week of treatment dressing removal was painless and continued to be so throughout the period of the trial(four weeks). Median surface area at baseline was 7.74 cm2 and was reduced by 54.5% at week 4 (relative area reduction). Median wound volumetric value was noted 12 ml at baseline and was reduced by 72.7% by the end of treatment. The cohesiveness of the new rope was considered very good by health professionals. No residue was observed on the wound bed during the dressing change with the new rope. There were no adverse events related to the tested rope, during this trial.Pain-free removal associated with good efficacy and tolerance were observed with this new cohesive rope in the healing process of deep cavity wounds and could represent a therapeutic alternative to the usual ropes used in such indications.

UrgoClean: a new dressing for desloughing exuding wounds

Wound debridement plays a key role in wound bed preparation and the healing of chronic wounds. A variety of techniques can be used to achieve debridement and autolytic debridement is frequently the clinician's first choice. This is aided by dressings including hydrogels and hydrocolloids, which provide the moist environment required for white blood cells to function. This product focus uses 12 case studies to examine the effectiveness of UrgoClean in wound debridement.

HI-TENS reduces moderate-to-severe pain associated with most wound care procedures: a pilot study

This study systematically examined pain associated with wound care procedures (WCPs) and evaluated the effectiveness of high-intensity transcutaneous electrical nerve stimulation (HI-TENS) for reducing this pain in a two-phase design. Phase 1 (N = 57) examined patient, wound, and procedural factors, as well as analgesic intake, associated with WCPs. Pain during the WCPs was rated on a 0-10 numerical scale. Subjects reported a mean pain of 6.0 (standard deviation 3.04) during Phase 1, with 43 (75.4%) subjects experiencing moderate or severe pain (i.e., ≥4). Subjects who received opioid and/or nonopioid analgesia 1 hr before or during the WCPs (36.8%) reported significantly higher pain levels than those who had not received analgesia (p = .013). In Phase 2, 23 subjects with ≥4 pain during Phase 1 had HI-TENS applied to the area surrounding the wound during the WCPs. HI-TENS significantly reduced WCP pain by a mean of 2.0 (±2.31; effect size = 0.67; p = .001). This effect was significant for subjects with severe Phase 1 pain (i.e., ≥8; effect size = 1.00; p = .007) but not for subjects with moderate Phase 1 pain (i.e., 4-7; effect size = 0.40; p = .053). These findings demonstrate that pain during WCPs is a significant problem, that nurses appropriately administer analgesics but these are not sufficient, and that using HI-TENS may further reduce pain, particularly in patients experiencing severe WCP pain.

Use of Urgotul SSD to reduce bacteria and promote healing in chronic wounds

This product focus seeks to give an overview of the management of wound bioburden in relation to the use of antimicrobial dressings, according to recent guidelines and best practice statements. Identification of critical colonisation/localised infection and the role of biofilms is a key aspect of effective wound management. Silver antimicrobial dressings are efficient in reducing bacteria in wounds, but must be used appropriately to prevent overuse. Silver sulphadiazine has traditionally been used for the treatment of burns or Pseudomonas infection in leg ulceration, often in a cream formation. This article will be looking specifically at the effective use of Urgotul SSD in three critically colonised/non healing wounds.

Avaliação da dor durante a troca de curativo de úlceras de perna

O estudo visou avaliar a dor em úlceras de perna, durante a troca de curativo e identificar os procedimentos mais dolorosos na opinião de usuários do SUS. Estudo transversal, conduzido com 76 usuários com úlceras de perna, sendo 69,8% homens, com média de idade de 57,8 anos (dp=13,2), atendidos em Unidades Básicas de Saúde e Ambulatório do Hospital das Clínicas de Goiânia, Goiás. Para avaliação da dor utilizou-se a Escala Numérica (0-10) e o Questionário de Dor de McGill. A ocorrência de dor durante o curativo foi de 76,3%, de intensidade moderada (Med=5, Q1=3, Q3=8, Min=1; Máx=10). Qualitativamente, a dor foi descrita como cansativa (63,2%) e latejante (55,3%). Os procedimentos mais dolorosos na opinião dos usuários incluíram a limpeza da ferida e a retirada do curativo anterior. A dor durante a troca de curativo de úlceras de perna foi frequente e exacerbada no momento da limpeza e retirada do curativo anterior.

Wound care for the plastic surgery nurse

The plastic surgery nurse is often confronted with various acute and chronic wounds. Appropriate wound care can facilitate healing, improve quality of life, decrease pain, and improve cosmesis. Yet, with more than 5,000 products on the market today, it can be difficult to choose the appropriate product. This article reviews some of the basic principles of wound healing and patient assessment and then presents a framework from which to develop a plan of care using appropriate wound care products. Appropriate product selection based on patient assessment and clearly defined wound-healing goals can lead to improved healing and saved health care resources.

A comparison of antibacterial activity against Methicillin-Resistant Staphylococcus aureus and gram-negative organisms for antimicrobial compounds in a unique composite wound dressing

OBJECTIVE

Antibiotic resistance is increasing among organisms that commonly cause wound infections. Therefore, it becomes increasingly desirable to prevent wound infections as systemic antibiotic treatment of established wound infections becomes more difficult, more expensive, and potentially more toxic. The ability to incorporate antimicrobial compounds into modern wound dressings provides an opportunity to prevent wound infections without the risk of systemic toxicity, thus diminishing morbidity, mortality, and cost to the healthcare system.

DESIGN

In these studies, the authors tested 16 antimicrobial agents in a unique composite wound dressing (TheraGauze; Soluble Systems, LLC, Newport News, Virginia) against clinical methicillin-resistant Staphylococcus aureus isolates and Gram-negative organisms commonly associated with wound infections and antibiotic resistance. Disk diffusion susceptibility testing is used to quantify antimicrobial activity.

RESULTS

Broad-spectrum antimicrobial activity was found for the following agents in the composite wound dressing: hydrogen peroxide, tobramycin, chlorhexidine digluconate, chlorhexidine gluconate, levofloxacin, and silver.

CONCLUSION

These studies suggest that potent local antibacterial activity can be achieved with several antimicrobials in this wound dressing.

Acute wound pain: gaining a better understanding

PURPOSE

To provide the wound care practitioner with an overview of research and knowledge about the causes, mechanisms, contributing factors, and management of acute wound pain.

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES

After reading this article and taking this test, the reader should be able to: 1. Describe the causes of acute wound pain. 2. Discuss research findings related to the physiology of wound pain. 3. Identify current concepts in the management of acute wound pain.