From the Journals

New tool helps predict severe pain during wound dressing changes


NEW YORK (Reuters) – A newly developed tool pinpointed three variables – type of dressing, expected pain, and resting pain – that can be used to predict which patients are likely to have severe pain during dressing changes, researchers say.

For clinical use, said Dr. Sue Gardner of the University of Iowa, College of Nursing, Iowa City, “scores on the three variables would need to be weighted based on the estimates from the backward elimination model and summed. This calculation would result in an estimate of the probability the patient will experience severe pain. Then the clinician (or institution) would determine which cut score or probability level corresponds to the sensitivity and specificity most desirable for that patient or institution.”

“The best way would be to develop an algorithm (pencil and paper or electronic) that the scores from each of the three predictors could be entered into that facilitates or automates computation of the probability score,” she told Reuters Health by email. “Development of a mobile app would be one way to achieve this.”

As reported in Pain, a one-time study dressing change was conducted by the same wound care nurse on 445 patients; patient and wound predictors and pain intensity were measured during the dressing change. About half the patients were under the age of 60, about half were women, and 94% were White.

All participants had full thickness, open wounds requiring a dressing change, not caused by a burn or diabetic foot ulcer mechanisms. Most wounds (86.5%) were acute.

Burn wounds were not included because the pain associated with them is substantially different from other types of wounds, according to the authors. Diabetic foot ulcers were not included because the neuropathic mechanism associated with these wounds alters the perception of pain in both the foot and the ulcer.

Three predictors emerged as most useful for a clinical prediction tool: type of dressing, resting wound pain, and expected pain. Algorithms based on these predictors are presented in the study that can be applied in other settings to predict patients likely to experience severe pain during a dressing change.

Dr. Gardner added that “a few clinical guidelines are available to guide (preventive) interventions, although they are quite vague and lack specificity. The mainstay of these guidelines is the administration of analgesics and the use of nonadherent dressings.”

“What type of intervention to use is an area in need of greater attention and further study,” she acknowledged. “At this point, we can give no clear direction on which interventions are effective.”

Dr. Jenny Alderden, a critical care nurse and associate professor at Boise State University, Idaho, whose research focuses on pressure injury prevention and wound care, commented on the study in an email to Reuters Health. “This is a critically important study because acute pain associated with wound dressing changes is undertreated,” she said. “Ideally, this type of pain should be addressed with careful dressing selection in combination with nonpharmacological pain management techniques and, if needed, analgesic medication – all of which require planning. An estimation of the patient’s likelihood of experiencing severe pain is thus a valuable tool for the wound dressing planning process.”

However, she added, “the study is limited by its single-site design. Future research is still needed to validate the model in an independent sample and establish external generalizability.”

“In addition, clinicians should remember that predictive models are helpful tools that can enhance but should not replace clinical judgment,” she said. “Predictive models may not work as well in populations under-represented in the study data.”

Dr. Michael Cooper, Director, Burn Service at Staten Island University Hospital, New York, also commented by email. “As a plastic surgeon who specializes in burn and wound care for over 24 years in a large metropolitan area, severe pain associated with wound dressing changes is a daily occurrence and challenging to predict and treat.”

“I will use the findings in my practice,” he said. However, “most patients were White. I would be interested to test these findings in a more diverse population. Research in burn patients is also an area for further (study).”

Reuters Health Information © 2022

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