Page 75 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

48 Chapter 2. Pain

pain but, as with the previous analgesics, it should be
delivered an hour before treatment. Additionally, clinicians
need to be aware of the actions and side-effects of opioids in
order to achieve good analgesia appropriate for pain man-
agement. Side-effects may include constipation, nausea/vom-
iting, sedation and respiratory depression (McNicol et al.
2003 ). When used solely for dressing change, practitioners
need to observe for each of these side-effects at each dose
administration. Pain can act as an antidote to respiratory
depression although, if administered during preparation for
dressing change (hence, a currently pain-free period), it is
essential to monitor the patients and their safety.
In addition to the analgesics within the WHO ladder, there
are co-analgesics that treat non-nociceptive elements of pain.
Although neuropathic pain and its associated symptoms
(including allodynia and hyperalgesia) are coincident with
nociceptive pain, they are unresponsive to the same drugs
used in the management of nociceptive pain. Differing to
nociceptive pain, neuropathic pain stems from within the
nerves themselves, thus medication targeting this area is
essential. Antidepressive and anticonvulsant co-analgesics
such as amitriptyline and gabapentin have proven useful in
managing such pain. However, clinicians should begin with
low doses, increasing if need be whilst accounting for poten-
tial side-effects.
Other pain management strategies can implement the use
of nitrous oxide, most commonly the 50:50 strength mixture
with that of oxygen. Although its mode of action for analgesia
is unclear, it is often useful when managing painful dressing
changes. It has very few side-effects and can be self-
administered via a mouthpiece or facemask. Thus, the patient
can inhale the substance in accordance with their perceived
pain. Additionally, nitrous oxide can be used in addition to
other analgesics with no contraindications. There are limited
disadvantages to the use of nitrous oxide and numerous
advantages. Firstly, training in the administration of the
equipment is relatively simple and quick, the equipment is
portable, and most forms of the 50:50 mixture are relatively