Page 248 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Pain 223

Pain

In a systematic review of studies on the impact of leg ulcers
on daily life Persoon et al. ( 2004 ) listed pain as the first and
most dominant factor and this has been fully explored in

Chap. 2 . Jones et al. ( 2006 ) found prolonged pain (along with
malodour) was the specific symptom associated with anxiety
and depression. Given the numerous negative effects of pain,
it is not surprising that healthcare practitioners unanimously
believed that reducing chronic wound pain could improve
patients’ psychological state significantly (Upton et al.
2012a , b , c ). However, in an interactive wound care survey of
246 wound conference delegates only 35 % of NHS commu-
nity staff and 44 % of NHS hospital staff considered that
wound pain was being addressed sufficiently (Lloyd Jones
et al. 2010 ). Given the over-riding significance of pain, the
reported poor support provided and the potential impact that
pain may have on treatment concordance, stress levels and
ultimately wound healing it is the key issue that clinicians
have to address in wound care through careful assessment
and management. Along with the underlying wound aetiolo-
gies and local trauma that is exacerbated at dressing change
(Woo and Sibbald 2008 ), a constellation of patient factors
including emotions, personality structure and stress are inte-
gral to the comprehensive assessment and management of
wound related pain. These can all be encapsulated under the
P.A.I.N. (Preparation, Assessment, Intervention and
Normalisation) model previously described (see Chap. 2 ).
There are many psychological therapies that can help the
patient deal with their pain. For example, cognitive therapy
that aims to modify attitudes, beliefs, and expectations has
been shown to be successful in the management of both stress
and pain. Furthermore, distraction techniques, imagery, relax-
ation or altering the significance of the pain to an individual
can also be successful in reducing pain. Patients can also learn
relaxation exercises to help reduce anxiety related tension in
the muscle that contributes to pain. These techniques can be
employed by the clinician, or referred on for more specialist
interventions and can help not only pain but stress and other