Abstract
Dressing change pain, which is considered procedural or acute cyclic pain, is often
cited by chronic wound patients as the worst pain they experience. This may illustrate the problems caused by using antiquated dressings, such as gauze wet-to-dry
dressings, that are ripped out of the wound and reinjure it with each dressing
change-starting the wounding process all over again. Many strategies can be
employed to minimize wound dressing change pain including:
1. Using pain-reducing dressings that cover the wound bed and exposed
nerve endings, adhere as little as possible and leave minimal residue
behind. Examples include hydrogels, foams, nonadherent dressings, or specialty absorptive dressings like hydrofibers or alginates. Dressings that
cause pain should be avoided, such as wet-to-dry gauze and adhesive dressings on certain areas of the body,
2. Managing wound exudates properly, so that it does not pool in the wound
bed causing local pressure and pain or leak out of the wound bed macerating or denuding the surrounding skin. If wound margins become macerated or denuded, cover them to prevent pain and further damage with a
moisture barrier ointment (e.g., petrolatum and zinc oxide), a hydrocolloid
or thin hydrocolloid dressing (that will stick to denuded skin) or a special
wound barrier dressing,
3. Avoiding the use of cytotoxic agents such as full strength povidone iodine,
which in and of themselves often cause pain when applied to wounds,
4. Minimizing the frequency of dressing changes by selecting advanced
wound dressings that require daily or every other day changes (as opposed
to twice a day or three times a day dressing changes),
5. Selecting a time of day for the dressing changes when that individual can
best tolerate the dressing change (e.g., mornings for morning people and
evenings of night owls),
6. Giving the person permission to call time-out if the pain gets to be too
great. Burn research has demonstrated that giving people this control
reduces pain scores related to dressing changes (26),
7. Allowing people who are able to change their own dressings, which often
causes less pain than when someone else does it, and
8. Using diversionary tactics at dressing changes to help reduce the pain