Topical treatment of pain in pressure ulcers: a systematic review

Background:

Pain is a common concern in patients with various types of chronic wounds including pressure ulcers.   Dallam and colleagues reported that 59% experienced some type of pain in a hospital setting.  A substantial number of the subjects perceived pain to be severe. In another study of patients with pressure ulcers, Szor and Bourguignon reported that as many as 84% of their subjects experienced pressure ulcer associated pain at rest while 88% acknowledged acute wound pain at dressing change.  

Purpose   

Wound related pain is often under-estimated and under-treated.  An effective local treatment may be preferred to a systemic treatment because of the reduced risk of side effects.  Little is known about the effective treatment for pressure ulcer related pain.  The purpose of this review is to identify and evaluate the effectiveness of topical agents to relief pressure ulcer related pain.

Method:

We searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE (1950 to February Week 3 2008), Ovid EMBASE (1980 to 2008 Week 08) and Ovid CINAHL (1982 to February Week 3 2008) to identify randomized controlled trials (RCTs) that evaluated the use of topical agents to relief pain in patients with pressure ulcers.  The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis.

MAIN RESULTS:

6 trials were identified that met the inclusion criteria. All trials evaluated the use of topical morphine in the management of pressure ulcer pain.  Pooled analysis indicated that topical morphine was associated with a reduction in pain scores (measured on a 100 mm scale) of 21.3 mm (95% Confidence Interval 30.11-10.19). CONCLUSIONS: Topical morphine may relief mild to moderate pain in patients with pressure ulcers.  However, the poor quality of most of the trial reports means the results should be interpreted with caution.