Pain from Open Wounds:

Informed Health On Line: [http://www.informedhealthonline.org/index.235.en.html]  The pain that chronic wounds cause is often under-estimated by people who have not experienced it. It can make daily life and sleeping difficult, and it can be depressing. Analgesics like paracetamol can help ease the pain. If these are not enough, a doctor could prescribe stronger pain relief that might be able to help better. It is especially important for people with chronic wounds, who are often in pain, to let their doctor and others know if they are suffering pain. In addition, friends and relatives can help by providing sympathy and support.


Another article on wound Pain: [http://www.o-wm.com/content/plain-talk-about-wound-pain] appears below:

Author(s):

Evonne Fowler, RN, CNS, CWOCN

To some degree, almost every person with an open wound experiences pain. The pain may occur during wound cleansing or debridement (noncyclic pain), during repeated treatments such as daily dressing changes or repositioning (cyclic wound pain), or during quiet time without manipulation (persistent pain).1 The pain experience might even be one of anticipation; the anxiety of a painful event potentially is as disabling and as real as physical pain. The manner of dealing with the pain and the condition varies with the individual, the circumstances, and the level of the tissue injury. Healthcare professionals are responsible for recognizing the person in pain, assessing the type of pain, and determining appropriate interventions for relieving/easing the pain.

Pain is the reaction to signals transmitted throughout the body but more importantly, pain is what the person says it is. It is an experience that cannot be separated from the patient’s mental state, environment, and cultural background. These factors can cause the brain to trigger or abolish the experience of pain, independent of what is occurring elsewhere in the body. When assessing pain, investigating relevant mental and environmental factors is critical.2

The pain experience is dynamic and variable and has been categorized in different ways. Acute pain is described as an identified event that resolves in minutes, hours, days or weeks. Acute pain is usually nociceptive — nociceptive (from the word noxious meaning harmful) pain is caused by an injury or disease outside the nervous system. Nociceptors are specialized nerve endings in skin and deeper tissue. The pain may originate from direct nerve stimulation of the intact fibers.3 The pain is often an ongoing dull ache or pressure, rather than the sharper pain characteristic of neuropathic pain. The severity of pain usually correlates with the level of tissue damage. Nociceptive pain triggers a protective reflex (eg, to move your hand immediately if you touch a hot object). The pain is a symptom of injured or diseased tissue — when the underlying problem is cured, the pain usually goes away. Nociceptive pain is usually finite and responds well to treatment with opioids.

With persistent (chronic) pain, the cause is not usually identified or may be multifactorial and often is of undetermined duration. The pain can be nociceptive and/or neuropathic. The nerves continue to send pain messages to the brain even though tissue damage has ceased.

Neuropathic pain is a form of chronic pain. Neuropathy is any functional and/or pathological change in the peripheral nervous system. The three types of neuropathy are sensory, motor, and autonomic. They may occur individually or combined. Neuropathic pain is caused by damage to nerve tissues/fibers and is often felt as a burning or stabbing pain (eg, the pain experienced with a pinched nerve). The pain is often chronic and does not respond well to opioids. Neuropathic pain may respond to antiseizure and antidepressant medications. Nerve irritation (burning and/or stinging pain) may respond to tricyclics (amitriptyline or nortriptyline). The shooting/stabbing pain of nerve damage responds well to anti-epileptic medication (eg, gabapentin). [Underlining added.]

References:

1. Krasner D. The chronic wound pain experience. Ostomy/Wound Management. 1995;41(3):20–25.
2. Richeimer SH, Bajwa ZH, Kahraman SS, Ransil BJ, Warfield CA. Utilization patterns of tricyclic antidepressants in a multidisciplinary pain clinic: a survey. Clin J Pain. 1997;13(4):324–329.
3. Reddy M, Kohr R, Queen D, Keast D, Sibbald RG. Practical treatment of wound pain and trauma: a patient-centered approach. An overview. Ostomy/Wound Management. 2003;49(4 Suppl):2S–13S.
4. Thomas S. Atraumatic dressings. World Wide Wounds. 2003; January. Available at www.worldwidewounds.com/2003/january/thoma/atraumatic-dressings.html. Accessed May 11, 2003.
5. Krasner D. Using a gentler hand: reflections on patients with pressure ulcers who experience pain. Ostomy/Wound Management. 1996;42(3):20–29.

Additional Resources
1. Paice JA. Understanding nociceptive pain. Nursing. 2002;32(3):74–75.
2. Moffat CJ, Franks P, Hollinworth H. Understanding wound pain and trauma: an international perspective. In: EWMA Position Document: Pain at Wound Changes. Medical Education Partnership LTD. London, UK 2002;2–7.
3. Kundu S, Achar S. Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician. 2002;66(1):99–102.
4. Menefee LA, Katz NP. The Pain EDU.org Manual: A Clinical Companion. Newton, Mass.: Inflexxion, Inc.;2003


Developing a Painful Bed Sore on Her Back

While in the hospital  during the January 4 to  January 14 period, Glenda developed a painful bed sore or pressure ulcer. These pressure ulcers can be very painful and require medical personnel trained and experienced in wound care. This attention was not given. While Rodney's daughters, Patty and Stephanie, were visiting Glenda at John Muir hospital, one of the nurses expressed concern about the wound on Glenda's back that wasn't being given adequate treatment. The nurse's concern about the appearance of the pressure ulcer caused her to take a picture of it for the record. The required special care was never provided.

Instead of providing recognized pressure ulcer treatment, hospital  doctors gave Glenda morphine-type pain medications. That had two major problems. One, the pressure ulcer worsened. Two, morphine drugs decrease pulmonary function, the exact opposite of the medical treatment Glenda needed.

Painful, Inadequately Treated, Bed (Pressure) Ulcer

Glenda also developed a painful  bed sore or pressure ulcer on her back while in the hospital, which was not given the medical attention that was needed at Manor Care. Medical records show constant reference to pain from a wound on her back. But not a single medical record mention any of the actions that must be taken to treat pressure ulcers. 

As described in a Mayo Clinic site (http://www.mayoclinic.com/health/bedsores/DS00570) , these actions include:

  • Tests, such as tissue  cultures to diagnose a bacterial or fungal infection.
     
  • Determining the size and depth of the ulcer.
     
  • Tissue cultures to check for cancerous tissue needing surgery.
     
  • Treatment by a physician dealing in wound care; a wound specialist.
     
  • Surgical, mechanical, enzymatic, or autolytic debridement of dead tissue.
     
  • Constant repositioning in bed.
     
  • Special cushions to take the weight off of the ulcer area.
     
  • Pain management that does not adversely affect pulmonary efficiency. This means avoidance of morphine sulfate or other morphine containing drugs that were used around the clock on Glenda. Topical rather than systemic pain medication would be indicated.
     
  • Avoidance of hospital bed positions that result in a shearing effect as the patient slides and  irritates the bed ulcer.

The pathetic primitive attention given to this medical problem resulted in Glenda suffering continual pain that eventually played a key role in giving up the will to live and return home.

Reverse of Proper Medical Attention
Given to Glenda's Pressure Ulcer

 

Developing a Painful Bed Sore on Her Back

While in the hospital  during the January 4 to  January 14 period, Glenda developed a painful bed sore or pressure ulcer. These pressure ulcers can be very painful and require medical personnel trained and experienced in wound care. This attention was not given. While Rodney's daughters, Patty and Stephanie, were visiting Glenda at John Muir hospital, one of the nurses expressed concern about the wound on Glenda's back that wasn't being given adequate treatment. The nurse's concern about the appearance of the pressure ulcer caused her to take a picture of it for the record. The required special care was never provided.

Instead of providing recognized pressure ulcer treatment, hospital  doctors gave Glenda morphine-type pain medications. That had two major problems. One, the pressure ulcer worsened. Two, morphine drugs decrease pulmonary function, the exact opposite of the medical treatment Glenda needed.

Glenda also developed a painful  bed sore or pressure ulcer on her back while in the hospital, which was not given the medical attention that was needed at Manor Care. Medical records show constant reference to pain from a wound on her back. But not a single medical record mention any of the actions that must be taken to treat pressure ulcers. 

As described in a Mayo Clinic site (http://www.mayoclinic.com/health/bedsores/DS00570) , these actions include:

  • Tests, such as tissue  cultures to diagnose a bacterial or fungal infection.
     
  • Determining the size and depth of the ulcer.
     
  • Tissue cultures to check for cancerous tissue needing surgery.
     
  • Treatment by a physician dealing in wound care; a wound specialist.
     
  • Surgical, mechanical, enzymatic, or autolytic debridement of dead tissue.
     
  • Constant repositioning in bed.
     
  • Special cushions to take the weight off of the ulcer area.
     
  • Pain management that does not adversely affect pulmonary efficiency. This means avoidance of morphine sulfate or other morphine containing drugs that were used around the clock on Glenda. Topical rather than systemic pain medication would be indicated.
     
  • Avoidance of hospital bed positions that result in a shearing effect as the patient slides and  irritates the bed ulcer.

The pathetic primitive attention given to this medical problem resulted in Glenda suffering continual pain that eventually played a key role in giving up the will to live and return home.


Return to www.defraudingamerica.com/glenda

 

 

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