How to deal with the dull pain of a wound?

Wound pain, this seemingly simple phenomenon, actually hides two different types of pain: nociceptive pain and neuropathic pain. The World Federation of Wound Healing Societies reveals that this pain may result from tissue damage or nervous system dysfunction. Although the two have different origins, they respond differently to treatment modalities.

Nociceptive pain :

It acts like a sharp stabbing pain, a warning to us after tissue injury, prompting our nerves to send pain messages to the brain.

Neuropathic pain :

It is a more complex pain that makes us feel a burning, tingling, or stinging sensation at the wound. This is usually the source of chronic pain and originates from damage or dysfunction of the nervous system.

Although nociceptive pain and neuropathic pain are two major sources of wound pain, their real-life manifestations vary. Sometimes we feel pain at the wound site while we are resting. This is known as background pain. And when we carry out daily activities, such as sneezing, coughing, walking, or changing posture, the pain of the wound may be intensified. This is concomitant pain. In addition, procedural pain may occur when we perform activities such as changing wound dressings. Surgical pain comes from wound intervention, such as debridement or biopsy and other invasive procedures.

To treat wound pain, we need to choose a suitable treatment plan based on the nature of the wound. Whether it is an acute or chronic wound, our goal is to improve wound healing and improve the patient's quality of life. When it comes to pain management, we can start with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and gradually escalate to opioids, but we need to be careful when using them to avoid addiction. Additionally, researchers have found that anticonvulsant medications can also help control wound pain. Applying local anesthesia before changing the dressing can help the patient better tolerate this painful procedure.

In the process of exploring how to better deal with wound pain, we need to fully understand the reasons behind it, and choose appropriate analgesic drugs and treatment options, and we also need to pay attention to the feelings of patients so that they can feel warmth and care in their pain. When looking for ways to relieve pain, we have to mention those more intensive anesthesia methods. Regional or epidural nerve blocks, or even lumbar sympathectomy, can effectively suppress chronic and painful wound pain. However, in addition to pharmacological interventions, we also have a number of non-invasive, non-pharmacological pain management options.

Imagine that through transcutaneous electrical nerve stimulation (TENS), we can use weak currents to stimulate nerves to relieve pain. Alternatively, ultrasound therapy and pulsed radiofrequency energy (PRFE) can also play an important role in reducing pain. They work by stimulating tissue to relieve pain.

When it comes to dressing changes, we recognize that involving patients not only reduces their anxiety but actually aids the wound-healing process. Sometimes, a simple distraction like listening to music is enough to make the patient comfortable enough to complete a dressing change. If a pain-relieving treatment plan can be developed for patients before starting a dressing change, their overall experience and healing effects will be significantly improved.

Of course, we cannot ignore the importance of infection control. Preventing and controlling wound infections is critical because infected wounds can significantly increase the intensity of pain. Depending on the condition of the wound and the culture results of the exudate, we can choose appropriate antimicrobial and antibiotic treatment to reduce the infection and associated pain. These antibiotics can be given intravenously or orally. Additionally, topical antimicrobial therapy during standard dressing changes is a viable option for treating wound infections.

Wound pain has a huge impact on a patient's quality of life. Therefore, we need to provide them with multiple treatment options, including non-pharmacological, pharmaceutical, non-invasive, invasive, palliative, and invasive. With the guidance of our medical staff, we can help our patients choose the method that works best for them to manage acute and chronic wound pain. It may take some experimentation to find the best approach, but the patience and clinical expertise of healthcare professionals, along with the active participation of patients, will be key to how we find the best and most effective approach.

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Editor: kiki Jia

Date: February 16, 2023