Page 73 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

46 Chapter 2. Pain

these assessments can provide clinicians with an insight into
their patient’s experience of pain, it is necessary to combine
these scores with anecdotal experience in order to identify
potential magnification or underplaying of pain intensity. As
such, an individualised, patient-centred approach is essential
(Nielsen et al. 2009 ). Chronic pain, however, differs in that
patients experiencing this type of pain can show little variation
in its intensity over time (Stomski et al. 2010 ). Hence, intensity
score such as the VAS may prove ineffective. Rather, it is more
appropriate to use measures such as the MPQ. In doing so, the
clinician can gain a deeper understanding of the contributing
factors of increased and reduced pain. Taking the time to con-
sider patient’s experience of pain, and on pain experienced
during previous treatment and dressing regimes, can equip
clinicians with the understanding and knowledge of how to
accurately manage that pain. Thus, multi-dimensional mea-
sures such as that of the MPQ can account for all the biopsy-
chosocial elements needed in doing this.

Intervention

A multi-modal approach to pain management is more effec-
tive than a single pharmacological agent (Hollinworth 2005 ;
White 2008 ). Not only does this approach need to be imple-
mented when managing on-going wound pain, but is also
important when approaching the problematic pain inducing
nature of dressing change (Upton 2011a , b ; Woo et al. 2009 ).
The multi-modal approach to pain management is one which
is embedded within the World Health Organisation (WHO)
analgesic ladder (WHO 2010 ) into practice. It is particularly
effective in relation to pain management in that it ensures
that all pain pathways are targeted in an attempt to relieve
patients’ experience of pain.
There are a number of analgesic medications which can
prove useful in targeting pain, differing in relation to wound
and pain type. Firstly, bottom of the WHO ladder, paracetamol
is a widespread analgesic which should be used as a basis for