Pain Management in Patients with Chronic Wounds
- 69 Downloads
Purpose of Review
Chronic wounds are increasing in prevalence and are often associated with significant pain, which can have a major impact on quality of life. Safe and effective pain management can be challenging, an unfortunate reality that is highlighted by the ongoing opioid crisis. This review aims to provide an evidence-based framework for pharmacologic and non-pharmacologic pain management in patients with chronic wounds.
As reflected in the new CDC guidelines, no study has shown that long-term opioid use mitigates chronic pain. Non-pharmacologic therapies, including virtual reality and acupuncture, have shown efficacy and are promising adjuvant therapies for pain management.
Non-opioid pharmacotherapies and non-pharmacologic therapies are preferable to opioids for chronic pain related to non-healing wounds. The experience of pain is a subjective and complex biopsychosocial process that necessitates a rational, personalized, and often multimodal approach to management.
KeywordsChronic wounds Pain management Opioids Wound healing Wound pain Venous leg ulcer
Every author listed meets the qualifications for authorship and has had the opportunity to read and comment upon the submitted manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 1.• Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17(6):763–71. Provides a good overview of the burden that chronic wounds pose to society and the relevance from a public health prespective. CrossRefPubMedCentralPubMedGoogle Scholar
- 2.Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007;(386):1–32.Google Scholar
- 3.Kurz X, Kahn SR, Abenhaim L, Clement D, Norgren L, Baccaglini U, et al. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. Int Angiol. 1999;18(2):83–102.PubMedPubMedCentralGoogle Scholar
- 5.•• Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and management of lower-extremity ulcers. N Engl J Med. 2017;377(16):1559–67. Thorough but concise overview on how to manage patients with chronic wounds, including venous, arterial, diabetic, and pressure ulcers. CrossRefPubMedCentralPubMedGoogle Scholar
- 22.• Herskovitz I, MacQuhae FE, Dickerson JE, Cargill DI, Slade HB, Margolis DJ, et al. Opioids’ effect on healing of venous leg ulcers. J Invest Dermatol. 2017;137(12):2646–9. Study found that a high percentage of patients with chronic venous ulcers were prescribed opioids and that opioid use was negatively associated with wound healing. CrossRefPubMedCentralPubMedGoogle Scholar
- 23.•• Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374(2):154–63. Paper outlines the opioid crisis in the USA and provides an in-depth prospective on the close correlation between rising opioid prescriptions, opioid abuse, and related morbidty and mortality. CrossRefPubMedCentralPubMedGoogle Scholar
- 24.Crane EH. Emergency Department Visits Involving Narcotic Pain Relievers. The CBHSQ report. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville, MD.2015.Google Scholar
- 26.Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240–52.CrossRefGoogle Scholar
- 35.• Peppin JF, Albrecht PJ, Argoff C, Gustorff B, Pappagallo M, Rice FL, et al. Skin matters: a review of topical treatments for chronic pain. Part two: treatments and applications. Pain Ther. 2015;4(1):33–50. See article for detailed review of topical therapies for chronic pain, including numerous citations for studies looking at various pharmacotherapies. CrossRefPubMedCentralPubMedGoogle Scholar
- 40.Gottrup F, Jørgensen B, Karlsmark T, Sibbald RG, Rimdeika R, Harding K, et al. Reducing wound pain in venous leg ulcers with Biatain Ibu: a randomized, controlled double-blind clinical investigation on the performance and safety. Wound Repair Regen. 2008;16(5):615–25.CrossRefPubMedCentralPubMedGoogle Scholar
- 49.• Peppin JF, Albrecht PJ, Argoff C, Gustorff B, Pappagallo M, Rice FL, et al. Skin matters: a review of topical treatments for chronic pain. Part one: skin physiology and delivery systems. Pain Ther. 2015;4(1):17–32. See article for detailed review of topical therapies for chronic pain, including numerous citations for studies looking at various pharmacotherapies. CrossRefPubMedCentralPubMedGoogle Scholar
- 50.• Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–73. Updated evidence-based guidelines from the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain for pharmalogical management of neuropathic pain. CrossRefPubMedCentralPubMedGoogle Scholar
- 52.•• Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45. Updated CDC guidelines on prescribing opioids for chronic pain, which recommend non-opioid and non-pharmacologic therapies, citing the lack of evidence for opioids. CrossRefPubMedGoogle Scholar
- 55.Derry S, Moore RA. Single dose oral aspirin for acute postoperative pain in adults. Cochrane Database Syst Rev. 2012;4:CD002067.Google Scholar
- 58.Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102(4):822–31.CrossRefPubMedCentralPubMedGoogle Scholar
- 59.Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011;9:CD008659.Google Scholar
- 63.Derry S, Derry CJ, Moore RA. Single dose oral ibuprofen plus oxycodone for acute postoperative pain in adults. Cochrane Database Syst Rev. 2013;6:CD010289.Google Scholar
- 70.Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev. 2007;4:CD005454.Google Scholar
- 77.Federman DG, Poulin LM, Ruser CB, Kravetz JD. Implementation of shared medical appointments to offer battlefield acupuncture efficiently to veterans with pain. Acupunct Med 2017.Google Scholar