Pressure ulcer pain: a systematic literature review and national pressure ulcer advisory panel white paper.

Pain is an ever-present problem in patients with pressure ulcers. As an advocate for persons with pressure ulcers, the National Pressure Ulcer Advisory Panel (NPUAP) is concerned about pain. To synthesize available pressure ulcer pain literature, a systematic review was performed of English language literature, specific to human research, 1992 to April 2008, using PubMed and the Cumulative Index in Nursing and Allied Health Literature. Fifteen relevant papers were found; they examined pain assessment tools, topical analgesia for pain management, and/or descriptions of persons with pressure ulcer pain. Studies had small sample sizes and included only adults. The literature established that 1) pressure ulcers cause pain; 2) pain assessment was typically found to be self-reported using different versions of the McGill Pain Questionnaire, Faces Rating Scale, or Visual Analog Scale; 3) pain assessment instruments should be appropriate to patient cognitive level and medical challenges; 4) in some cases, topical medications can ease pain and although information on systemic medication is limited, pain medications have been found to negatively affect appetite; and 5) wound treatment is painful, particularly dressing changes. Research gaps include the prevention and treatment of pressure ulcer pain, the impact of pain on nutrition, and pressure ulcer pain considerations for special groups (eg, children, end-of-life patients, and bariatric patients). The NPUAP presents this white paper as the current scientific know-ledge base on the topic. Research regarding the multidimensional aspects of pressure ulcer pain is strongly recommended.

[1]  Ulkü Yapucu Güneş A descriptive study of pressure ulcer pain. , 2008, Ostomy/wound management.

[2]  P. Shekelle,et al.  Evidence for Improving Palliative Care at the End of Life A Systematic Review , 2008, Annals of Internal Medicine.

[3]  P. Shekelle,et al.  Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians , 2008, Annals of Internal Medicine.

[4]  T. Defloor,et al.  The experience of living with a pressure ulcer. , 2007, Nursing times.

[5]  M. Baharestani,et al.  Pressure ulcers in neonates and children: an NPUAP white paper. , 2007, Advances in skin & wound care.

[6]  Jane Nixon,et al.  Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. , 2007, Journal of advanced nursing.

[7]  T. Defloor,et al.  Patient stories of living with a pressure ulcer. , 2006, Journal of advanced nursing.

[8]  R. Zaslansky,et al.  [A Hebrew version of the FLACC scale: measurement of pain in non-verbal children]. , 2006, Harefuah.

[9]  C. Lyder Effective management of pressure ulcers. A review of proven strategies. , 2006, Advance for nurse practitioners.

[10]  Deborah Rastinehad Pressure Ulcer Pain , 2006, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[11]  P. Lesage,et al.  Palliative management of pressure ulcers and malignant wounds in patients with advanced illness. , 2006, Journal of palliative medicine.

[12]  D. Langemo When the Goal Is Palliative Care , 2006, Advances in skin & wound care.

[13]  T. Voepel-Lewis,et al.  The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment , 2006, Paediatric anaesthesia.

[14]  B. Pieper,et al.  Injection drug use and wound care. , 2005, The Nursing clinics of North America.

[15]  T. Achterberg,et al.  Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature. , 2005 .

[16]  J. Lowery,et al.  Assessing Persistent Pain and Its Relation to Affective Distress, Depressive Symptoms, and Pain Catastrophizing in Patients with Chronic Wounds: A Pilot Study , 2004, American journal of physical medicine & rehabilitation.

[17]  W. Prentice,et al.  Topical benzydamine cream and the relief of pressure pain , 2004, Palliative medicine.

[18]  D. Weiner,et al.  Is Chronic Nonmalignant Pain Associated with Decreased Appetite in Older Adults? Preliminary Evidence , 2004, Journal of the American Geriatrics Society.

[19]  A. Popescu,et al.  Wound Pain: A Challenge for the Patient and the Wound Care Specialist , 2004, Advances in skin & wound care.

[20]  S. Gallagher,et al.  Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges. , 2003, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[21]  D. Berlowitz,et al.  Pressure Ulcer Research Funding in America: Creation and Analysis of an On-Line Database , 2003, Advances in skin & wound care.

[22]  G. Zeppetella,et al.  Analgesic efficacy of morphine applied topically to painful ulcers. , 2003, Journal of pain and symptom management.

[23]  K. Herr,et al.  Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults. , 2003, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[24]  P. Flock Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain. , 2003, Journal of pain and symptom management.

[25]  Madhuri Reddy,et al.  Pain in pressure ulcers. , 2003, Ostomy/wound management.

[26]  T. Shafi,et al.  Management of the hospitalized injection drug user. , 2002, Infectious disease clinics of North America.

[27]  C. Fox Living with a pressure ulcer: a descriptive study of patients' experiences. , 2002, British journal of community nursing.

[28]  Jean-Luc Bosson,et al.  Assessing pain in critically ill sedated patients by using a behavioral pain scale , 2001, Critical care medicine.

[29]  C. Smyth,et al.  Pain Measurement Scales: A Comparison of the Visual Analogue and Faces Rating Scales in Measuring Pressure Ulcer Pain , 2001, Journal of Wound, Ostomy and Continence Nursing (WOCN).

[30]  J. Stanik-Hutt,et al.  Patients' perceptions and responses to procedural pain: results from Thunder Project II. , 2001, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[31]  N. Bergstrom,et al.  Pain assessment in the cognitively impaired and unimpaired elderly. , 2000, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[32]  D. Langemo,et al.  The lived experience of having a pressure ulcer: a qualitative analysis. , 2000, Advances in skin & wound care.

[33]  J. Szor,et al.  Description of pressure ulcer pain at rest and at dressing change. , 1999, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[34]  C. Cleeland,et al.  Pain and Treatment of Pain in Minority Patients with Cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study , 1997, Annals of Internal Medicine.

[35]  C. Paustian,et al.  Wound assessment and decision-making options. , 1996, Critical care nursing clinics of North America.

[36]  D. Krasner Using a gentler hand: reflections on patients with pressure ulcers who experience pain. , 1996, Ostomy/wound management.

[37]  J. Ermer-Seltun,et al.  Implementation of a comprehensive skin care program across care settings using the AHCPR pressure ulcer prevention and treatment guidelines. , 1996, Ostomy/wound management.

[38]  C. Smyth,et al.  Pressure ulcer pain: assessment and quantification. , 1995, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[39]  S. Krechel,et al.  CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability , 1995, Paediatric anaesthesia.

[40]  BridgetA. Jepson Relieving the pain of pressure sores , 1992, The Lancet.

[41]  D. Krasner,et al.  Chronic Wound Care: A Clinical Source Book for Healthcare Professionals , 1990 .

[42]  S. Thomas Pain and wound management. , 1989, Community outlook.

[43]  T. van Achterberg,et al.  Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature. , 2005, Journal of clinical nursing.

[44]  T. Voepel-Lewis,et al.  The FLACC: a behavioral scale for scoring postoperative pain in young children. , 1997, Pediatric nursing.

[45]  C. Williams Pain in pressure sores. , 1997, Community nurse.

[46]  D. Wong,et al.  Pain in children: comparison of assessment scales. , 1988, The Oklahoma nurse.