Page 77 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

50 Chapter 2. Pain

Table 2.6 Potential mechanisms of analgesic properties of dressings
(Richardson and Upton 2010 )
Out of sight, out of mind
The dressing as a protector
Moist environment – bathing of nociceptors

Moist environment – control of inflammation and hyperalgesia
Moist environment – recruitment of analgesic compounds to
the wound area
Temperature change – generating heat or cooling effects
Counter-irritation
Removal of irritant exudate

The sequestration of pro-inflammatory cytokines
The direct influence of the dressing material

change procedure. When considering the pathways initiated
during the experience of painful sensations, ten mechanisms
have been identified for the analgesic properties of dressings
(Richardson and Upton 2010 ; Table 2.6 ). The identification of
such mechanisms is needed in order to, subsequently, test
them. Psychological factors are an essential component of
these mechanisms, which leads us to the final stage of the
P.A.I.N. model of pain management, normalisation.

Normalisation

This final stage of the pain management model aims to return
the patient to their original or new optimal condition, result-
ing in little or no painful effect on on-going activities.
Anticipation of pain has been found to activate similar areas
of the brain to that of actual pain (Fairhurst et al. 2007 ;
Watson et al. 2009 ). Consequently, it is essential that the clini-
cian use normalisation techniques in order to counter the
anticipation, resulting in a pain-free dressing change and