OK_ Journal Wounds Related Pain Features, Assessment & Treatment.doc

WOUND RELATED PAIN FEATURES,
ASSASSMENT AND TREATMENT
This task is structured to meet the task of critics journal Integumentary
system

BY :
DADANG PUTRAWANSYAH

(105070200131003)

ISA ARIYANTI

(105070200131005)

ANGGRAENI CITRA SETYANINGTYAS

(105070200131007)

K3LN NURSING DEPARTMENT
MEDICAL FACULTY
BRAWIJAYA UNIVERSITY
MALANG
2011

WOUND RELATED PAIN FEATURES, ASSESSMENT AND
TREATMENT
Identification:
The management of wound-related pain has received increasing
attention over recent years. In the past seven years, five guidance
documents aimed at practitioners caring for patients with painful wounds
have been issued (European Wound Management Association (EWMA)
2002, Wounds-UK and Mölnlycke Health Care 2004, World Union of Wound
Healing Societies (WUWHS) 2004, 2007, Coloplast 2008).
If we talk about injuries, of course, we will talk about pain. In this
journal, explores the problem of wound-related pain. It provides an
overview of the different types of pain associated with wounds, discusses
approaches to pain assessment and considers a range of strategies that
may be used to minimise wound-related pain.
Analysis:
 Type of wound-related pain:
 Operative
 Procedural
 Incident
 Background

 Defining pain
The most widely cited definition of pain states that pain is: an
unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage’
(International Association for the Study of Pain (IASP) 1994).
 Nociceptive pain (occurs in everyday life)
Example : sprain, hurt himself, etc.
Nociceptors (sometimes referred to as pain receptors) are located at
the

distal

end

of

sensory

neurons,

which

transmit

external

information from the peripheral nervous system to the central
nervous system via the spinal cord.
 Neuropathic pain (can harm the central nervous system)
Example : Trauma, infection, metabolic disorders, include: burning,
tingling, or shooting sensations electric.
Neuropathic pain Neuropathic pain (sometimes referred to as
neurogenic pain) has been defined as an inappropriate response
caused by a primary lesion or dysfunction in the nervous centre
(WUWHS 2004). The causes of neuropathic pain are less well
understood (Clay and Chen 2005), but nerve damage as a result of

trauma, infection, metabolic disorders or cancer are often implicated
in this type of pain (WUWHS 2004).
 Approach to assess pain :
1. Wong beaker scale
2. Visual analog scale
3. Numerical rating scale
4. Verbal rating scale
The interesting thing in this journal is a statement of pautex et al
(2007) which said that the use of a tool called Doloplus - 2. This tool is
successfully used in the assessment of pain in patients with dementia.It’s
used for patients who can not verbally communicate pain and observe
the patient's behavior as a measure of pain.

 Inhibitors to assess and manage wound-related pain is :
1. Patient dificult to communicate with nurses
 The strategies to cope with the pain a patient is :
1. Nonfarmacologic
Examlpe : distraction, relaxation techniques, music therapy, patient
involvement, and provide information.

2. Farmakologic
WHO has developed a three-step ladder for managing cancer
pain, which is also recognised as a valuable approach to managing
wound-related pain (EWMA 2002), it recommends a step wise
approach

to

the

selection

of

analgesia,

with

the

additional

consideration of co-analgesics or adjuvant medication to provide a
comprehensive drug-based treatment where more complex pain
symptoms exist. Examples of co-analgesics include the tricyclic
antidepressants and anticonvulsants, which can be added to an
analgesic regimen where

evidence

of neuropathic pain exists

(WUWHS 2004).

As shown in Figure 3, the basic progression of analgesic
medication is from non-opioids (step 1), to weak opioids, for example
codeine, (step 2), and finally to strong opioids such as morphine (step
3). Steps 2 and 3 of the ladder indicate that combinations of nonopioids and opioids should be considered. Although the model seems
to imply that patients should be commenced at step 1 of the pain
relief ladder, this is not always the case and individuals who
experience high levels of pain will need to commence an analgesic
regimen based on either step 2 or 3 of the ladder (WUWHS 2004).

Non-steriodal anti-inflammatory drugs (NSAIDs) dampen sensitivity
and are particularly useful for controlling the throbbing or aching pain
felt aftera procedure such as a wound dressing (WUWHS 2004).
Application of the research result in health care setting in
Indonesia :
The methode to assessment pain in this journal similar to the way
assessments in Indonesia in general, which sets it apart is the method of
Wong glass, and doloplus_2. So it might be applied in Indonesia.
The excess of this journal :
1. In this paper discussed a method for assessing pain Doloplus - 2.
2. In this paper a full discussion of the appropriate type of pain, etc.
3. It’s also discusses how the strategies used for save the obstruction to
nurses in assessing and manage pain-related injuries. Example :
Putting the emotional and or physical distance between the nurse
with the patient's pain.
The shortage of this journal :
1. Types of injuries covered are not specific, so the handling is discussed
extending the reach of handling every aspect.
2. Not foccusing the discussion in this journal, so it can not find a
specific valuation approach for a particular type of injury.