Background:

Pain is a significant concern in patients with chronic wounds.  New evidence suggests that anxiety may lower the threshold and tolerance to pain.   Using a hierarchical regression model, Aaron and colleagues (2001) demonstrated that increased anxiety on a rating scale was a significant predictor of procedural pain during dressing change in burn patients.  However, little is known how anxiety, and anticipatory pain is related to procedural pain in patients with chronic wounds.  Further understanding of the relationship may provide directions to mitigate pain and suffering in this population.

Method:

The purpose of this study is to evaluate the relationship between pre-dressing change anxiety, anticipatory pain and pain during the dressing change procedure in the older population.  Ninety-six patients with chronic wounds were asked to rate their anxiety level (Spielberger State-Trait Anxiety Inventory short form) and anticipatory pain (0-10 numeric rating scale) before dressing change.  Pain levels were measured at dressing removal, cleansing of the wound, and application of dressing. 

Results:

Anxiety levels before dressing change were significantly related to anticipatory pain (r=.661), pain at dressing removal (r=.527), and pain at cleansing (r=.436) (all p values <0.01). 

Findings of this study suggest that the assessment of patients' anxiety should be part of chronic wound pain evaluation and management.

1. Aaron LA, Patterson DR, Finch CP, Carrougher GJ, Heimbach DM The utility of a burn specific measure of pain anxiety to prospectively predict pain and function: a comparative analysis.
   
2. Krasner D. Painful venous ulcers: themes and stories about living with the pain and suffering. J WOCN. 1998; 25(3): 158-9, 161-8

3. Pieper B.  Rossi R.  Templin T.  Pain associated with venous ulcers in injecting drug users.  Ostomy Wound Manage.  1998;  44(11): 54-8, 60-7.

4. Nemeth KA.  Harrison MB.  Graham ID.  Burke S.  Understanding venous leg ulcer pain: results of a longitudinal study.  Ostomy Wound Manage.  2004; 50(1): 34-36.