When Nociceptive and Psychogenic Pain are the Primary Obstacles to Providing Appropriate Wound Care

Purpose:  To demonstrate the use of a soft silicone silver foam transfer dressing for managing patients with nociceptive and psychogenic pain related to wound manipulation and the associated anticipation and anxiety related to care.  Two primary goals were identified at the inception of this alternative POC: 1) achieving optimal clinical outcomes and 2) improved patient satisfaction.

Background:  Per standard wound care principles, tactile manipulation for assessment, cleansing and preparation of the wound/skin surface followed by topical application of the appropriate product is unavoidable.  Patients refuse care and therefore prohibit staff from providing care utilizing measures that have demonstrated optimal outcomes supported by evidence based guidelines.  Addressing this challenge required the identification of a product that focused on minimizing pain, reducing the frequency of dressing changes, and managing strike-through drainage without disrupting the primary dressing.  Success was defined and dependent upon: 1) The patient’s reaction to the proposed POC  2) The patient’s reported pain levels prior to dressing removal, with dressing application and after completion of care 3)  The patient’s anxiety related to the anticipation of a predictable dressing change schedule and 4) The patient’s perceived outcome for healing.

Method:  Three patients were identified that met the criteria for an alternate plan that focused on minimizing pain, reducing anxiety, encouraging patient participation in co-managing the care.   All patients had partial thickness wounds with a bacterial and/or fungal component that required daily cleansing and dressing changes.   Selected dressings were placed to skin folds and peri-tube skin surfaces with a reduced routine dressing change frequency of every 5-7 days.

Results:  The dressing selected for use allowed us to effectively address the patient’s nociceptive and psychogenic pain while obtaining optimal clinical outcomes.  Patient satisfaction levels increased from the previous refusal of care to a positive anticipation of our visit for the dressing change.