Wound Considerations

With superficial wounds such as abrasions or donor sites, dressing selection can in itself help pain management and use of a moist wound healing dressing may be all that is required.

Radiotherapy can cause heat, burning, erythema and skin changes, which should be treated locally and associated pain treated on the basis of a thorough pain assessment. Radiotherapy can also make the tissue very friable and at increased risk of trauma, so avoid the use of tapes, adhesives or dressings which may adhere to the wound bed.

Superficial pressure ulcers, particularly those on the heel or sacrum, are at severe risk of further trauma and increased pain. They require dressings which can protect both the wound bed and the surrounding area from frictional forces, but these should not be a substitute for correct assessment of a patient at risk of pressure damage.

Patients with leg ulcers may have pain caused by a variety of underlying medical conditions. The skin surrounding the ulcer is very vulnerable to trauma, skin breakdown and increased pain from exudate, so dressings should both control exudate and prevent leakage onto surrounding skin.

Patients with fungating wounds can have increased pain due to active disease, complicated by associated emotions and other factors, such as wound odour, which can cause added distress. Dressings and pain management strategies must be selected on the basis of the patient's wound, pain and emotional status.