Page 55 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

28 Chapter 2. Pain

an unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage.
Pain is usually transitory, lasting only until the noxious
stimulus is removed or the underlying damage or pathology
has healed- this is acute pain. For example, acute pain may be
exacerbated during regular treatment due to the need for
manipulation; wound cleansing, dressing removal and re-
application, debridement (White 2008 Upton 2011a , b ).
;
However, some painful conditions may persist for years.
This is chronic pain, as opposed to acute pain that may be
experienced for a relatively brief period (e.g. during dressing
change). The definition of chronic pain is rather arbitrary,
however. The most commonly used definition being pain of
greater than 3 or 6 months since the onset of pain (Turk and
Okifuji 2002 ) though others have suggested a 12 month mark
(Spanswick and Main 2000 ). Others apply acute to pain that
lasts less than 30 days, chronic to pain of more than 6 months
duration, and subacute to pain that lasts from 1 to 6 months
(Thienhaus and Cole 2002 ). Alternatively, a compromise defi-
nition is that chronic pain is “pain that extends beyond the
expected period of healing” (Turk and Okifuji 2002 ) and one
that will be adopted here. Chronic pain may be an important
component of care for patients with wounds given the poten-
tial chronicity of their wound and the regular requirement for
dressing change.
In addition to the distinction between acute and chronic
pain, there are many forms of pain, which may be useful to
distinguish here. Hence, nociceptive pain is pain that happens
because of tissue damage or inflammation and is caused by
stimulation of peripheral nerve fibres that respond only to
stimuli approaching or exceeding harmful intensity:
Pain that arises from actual or threatened damage to non-neural
tissue and is due to the activation of nociceptors (ISAP 2012 )

Nociceptors are the nerves which sense and respond to
parts of the body, which suffer from damage. They signal tissue
irritation, impending injury, or actual injury. When activated,