Page 53 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

26 Chapter 2. Pain

healing. It is therefore essential that the health care professional
understand how pain is best conceptualised, assessed and
managed: this is the focus of this chapter. Detailing the pain
associated with wounds precedes a description of the Gate
Control Theory of Pain. This model highlights the importance
of psychosocial variables in the experience of pain and how
these components can also be used in the effective manage-
ment of pain. In order to effectively manage pain it is neces-
sary to assess pain appropriately and this chapter outlines
several methods which can be used in wound care. Finally,
approaches to pain management are presented.

Introduction

Pain and stress are two significant issues that can have a
demonstrable impact not only on the patient experience but
also on the healing of a patient’s wound. As will be discussed,
pain and stress are intrinsically linked and as such, pain has
been found to have a major role in the patient’s stress experi-
ence (Beitz and Goldberg 2005 ; Hareendran et al. 2005 ;
Upton et al. 2012a , b , c ). This can have significant conse-
quences for wound care since increased levels of stress can
lead to increased sensitivity to pain (Woo 2010 ). For example,
it has been found that patients, who display significant levels
of stress in anticipation of pain will, subsequently, rate their
painful experience as more intense (Colloca and Benedetti
2007 ). Similarly, increased stress from the pain may lead to
;
delayed healing (e.g. Upton et al. 2012a , b , c see Chap. 3 ).
This and the subsequent chapter will explore these two
fundamental issues, outline how they can be described and
look at how wound healing is influenced by these related
concepts. In this chapter, pain will be explored (see Box 2.1)

before moving onto Chap. 3 which will explore stress and the
inter-relationship between pain, stress and wound healing.
Research has highlighted the continual presence of pain
associated with wounds, not only in relation to the wound itself
but also during the wound-care regime (i.e. dressing change,