Pain Management for Complex Wounds

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Introduction   

When hearing about pain management for complex wounds, what comes to mind? What do you think of when caring for a client with complex wounds? If you’re a nurse, you’ve definitely seen some complex wounds in your career and have had to assess pain levels in various ways. Presently, clients seek guidance and information on various health topics from nurses, including pain management, complex wound care, and more. The information in this course will serve as a valuable resource for nurses of all specialties, education levels, and backgrounds to learn more about pain management for complex wounds.  

Defining Pain Management for Complex Wounds 

Pain management for complex wounds has existed since nurses have existed and before well into history. Complex wounds can significantly vary in client care. From severe pressure wounds to C-section infections to burns over half of a body, complex wounds are in almost every aspect of nursing care. While most severe forms of acute complex wound care are often seen in inpatient settings, many times, with the advances of technology and health care, many clients with complex wounds receive follow-up care in outpatient or home care settings. As a nurse, pain management and assessment are part of our skill set in clients from all walks of life and in various settings.  

Pain management for complex wounds can involve a variety of options, such as prescription medications, such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxers. In critical complex wound care settings, pain medications are often administered via IV, an infusion pump, injection, or via a patch. Several non-pharmacological interventions for pain management can include using compresses, repositioning a client, involving therapy, and more. Pain management for complex wounds has several studies and evidence-based research depending on the complexity of the wound, client health history, resources available, and medical intervention necessary (1,2,3,4,5). 

Specifically, complex wounds are well-studied and are a growing concern among health care. As America and the world has an increasing aging population, mobility concerns led to prolonged immobilization for millions of people, further adding to risks of pressure wounds, delayed wound healing, and complex wound care intervention. In particular, long-term care facilities, nursing homes, and critical care units with prolonged client stays are at increased risk of seeing complex wounds emerge even if clients were not admitted with complex wounds. Staffing concerns, documentation issues, and poor provider-client communication can lead to several cases of new complex wounds emerging within client care, making complex wounds a significant health care burden and risk.  

In addition, clients arriving to health care institutions with risk factors for complex wounds, such as poor skin integrity, immunocompromised health, or skin infection, are further at risk of complex wound development. While complex wounds can emerge outside of health care and be treated in health care facilities, such as burns, falls, and surgical complications, it is important to remember that pain management for complex wounds can vary client to client given on the severity of the client’s case itself (1,2,3,4,5,6,7).   

Pain management options for complex wounds are used in a variety of clinical settings for various client needs, such as in oncology nursing wards, long-term care facilities, intensive care units, and rehabilitation care centers. With the rise of technology, telehealth, home health nurses, and remote client monitoring, thousands of clients incorporate pain management for their complex wound care from their own home as well, sometimes even using an IV fusion pump at home (depending on the type of IV fusion prescription and extent of home health care). While many clients receiving pain management for complex wounds are in inpatient settings, as the demands for home health nursing and medical interventions shift, the reality is that many clients receive pain management options for complex wounds in non-clinical settings as well.  

Because pain management pharmacological interventions can be used for short or long durations (as little as a few days to a lifetime), it is important to remember that these medications can have severe life-threatening side effects. Nursing care and client monitoring must be followed to ensure that clients are receiving appropriate nutrition, maintaining good hydration, tolerating pain management options well, and showing improvements in health and quality of life. In particular, pain management, like all other medical interventions, is not guaranteed to have the same outcome on every client’s health. Some clients can have more severe pain management complications, such as anaphylaxis, inadequate pain management response, and worsening of client health status.  

Because there are several types of pharmacological and non-pharmacological pain management interventions, doses, frequencies, concentrations, and durations must all be considered in addition to the client response and health status, when assessing for response to pain management. Because of each client’s situation, it is important to make sure they are aware of the role of pain management in complex wound care and educated on the risks and benefits of pain management options (1-10).  

Complex Wound Prevalence 

The exact prevalence of complex wounds is not known, as several instances of complex wounds go undetected and unreported. While it is estimated that there are at least several hundred cases of reported complex wounds nationwide, true estimates anticipate this number to be higher given the number of people who do not regularly access health care services or who self-manage complex wounds in outpatient settings. It is estimated that complex wounds can affect millions of people throughout their lifetime. From pressure wounds to burns and everything in between, complex wound prevalence is not expected to decline anytime soon (1-10).  

Complex wounds are also found in all age groups, from neonatal to adolescent and geriatric populations. Even pregnant people can experience complex wounds during their pregnancy and postpartum, causing concerns for fetal and infant development and postpartum healing. While pain management prescriptions are often administered by a registered nurse (RN), some states and places of work also permit licensed practical nurses (LPNs) to administer medications as well. Pain medications and non-pharmacological interventions can be given at home as well, depending on the type of intervention, client condition, and home health nurse availability. As a result, for many clients, the role of caregivers, such as a parent or spouse, who can assist with monitoring a client’s complex wound condition can be helpful as well.  

In general, most acute care settings, hospitals, rehabilitation care centers, and long-term care facilities use some form of pain management in at least one client at any given time. It is important to note that complex wound prevalence for many people who are uninsured or who do not have access to health care can be self-managed with at-home care, over the counter (OTC) pain medications, and rest, which can also cause discrepancies in true prevalence in various inpatient and outpatient settings (1,2,3,4,5,6).  

What Causes People to Have Complex Wounds? 

Clients can have complex wounds for various reasons, such as accidents, natural disasters, surgical complications, physical trauma, burns, gunshots, amputations, and more. Complex wounds can take weeks or even months to develop; they can also develop within a few days as a result of an infection. Many things can trigger complex wounds, such as a small papercut that becomes infected over time. Complex wounds rarely emerge overnight, as they often are a result of several factors influencing someone’s skin, health, and overall immune system. For instance, a healthy adult could experience a severe burn from a kitchen fire and require complex wound care and pain management needs.  

Another client could be a geriatric adult with uncontrolled diabetes who has a toe fungal infection that has caused a complex foot wound as a result of not seeking care for weeks and not having adequate treatment for the initial toe fungal infection. Since there are many factors that can cause the development of complex wounds, taking a detailed health history and performing a detailed health assessment on clients is essential to excellent nursing care and for adequate pain management intervention (1,2,3,5,6,11,12,13).  

What Are the Various Pain Management Options for Complex Wounds? 

There are several Food and Drug Administration (FDA) approved medications to manage pain. Opioid medications are often among the first line for pain management for complex wounds, as they have been extensively studied and used in several client populations. Common opioid medications include codeine and morphine, both of which are prescription grade and available via pill, patch, shot, and IV fluid. That said, while opioid medications are often first-line for several types of complex wounds, they have severe possible side effects, such as respiratory depression, constipation, and coma, all of which can further impede wound healing and complicate the existing client’s health. As a result, careful client monitoring and education is important when administering opioids.  

Other pain medication options can include NSAIDs, such as ibuprofen and naproxen, or acetaminophen. While these medications are not as potent as opioids, titrating dosages, frequencies, and concentrations can be considered depending on the client’s health history and complexity of the wound. Many times, NSAIDs, opioids, and other pain medications, such as muscle relaxers, can be administered together to manage pain, as severe and chronic pain can have devasting effects of a client’s quality of life and healing process.  

While pain management is something to consider, the realities of polypharmacy, pre-existing health conditions, and role of education for caregivers and clients are factors to consider. Review your client needs, allergies, facility protocols, client condition, IV patency status, medication history, IV pump settings (if applicable), wound condition, and overall client progress when assessing for pain management and complex wounds (1,2,3,4,5,6,9,10,11,12,13). 

Non-pharmacological interventions for pain management for complex wounds can include music therapy, occupational therapy, physical therapy, hyperbaric therapy, talk therapy, peripheral nerve stimulation, frequent adequate dressing changes and wound irrigations, acupuncture, massage, frequent repositioning of the body, social support from caregivers and loved ones, adequate hydration and nutrition intake, and rest. While prescription pain medications are often the first line for complex wound healing and management, clients should be resting as often as possible in addition to maintaining adequate hydration and nutrition intake if possible. Depending on the severity of the wound, IV hydration might also be considered in addition ton IV pain medication.  

If possible, the client should try to move to prevent the skin from issues associated with prolonged immobility, such as pressure sores and skin irritation. Therapies are also possible depending on the extent of the complex wound and are often used in conjunction with pain medication. While acupuncture is often not done in inpatient settings, several clients report decreased pain with using acupuncture in outpatient settings. Social support can also play a role in pain management and wound healing (1,10,11,12,14,15,16,17,18,19,20).  

How and Where Are Pain Management Options Used? 

As mentioned above, pain management for complex wounds is used in several inpatient and outpatient settings presently. While many people can initially start using pain management in an acute care setting, many times, clients can also start using pain management options in an outpatient setting after clinical evaluation or until they are able to access inpatient care. Pain management options can be used whenever someone has access to pain management options, such as OTC medications, rest, hydration, and social support. Prescription and more advanced pain management options, such as opioids and nerve stimulation, are available in inpatient settings. During the administration of any medication, the client should be carefully monitored for any urgent side effects or allergic reactions.  

After medications have been administered, nurses should perform pain and wound assessments to monitor for response to therapy. Everyone’s response to pain management can vary, so that is something to keep in mind as well. With the rise of home health and telehealth interventions, many clients can receive complex pain management interventions in a hospital setting then transition to less medically invasive pain management options at home with a home health nurse and follow up with health care services as needed. Because of the growing prevalence of at-home nursing care and pain management and complex wound management outside of clinical settings, it is important to keep in mind the role of client education and nursing care in pain management and complex wound care management (1,2,3,4,10,11,14,18,19,20,21,22).  

What Are the Clinical Criterium for Pain Management for Complex Wounds? 

Clinical criterium for pain management for complex wounds can vary significantly depending on facility protocol, severity of the wound, and type of wound. Often times, clinical criterium for pain management for complex wounds takes into consideration client response to prior medical interventions, client age, and other demographics. Overall, clinician judgment and client response consider should guide the need for pain management, as pain management is often used for various clinical indications and for varied durations. Clinical criterium also needs to consider wound dressing, granulation of the skin tissue, amount of skin that has been harmed, and client response to any prior treatment.  

Pain management often includes opioids as first line, and administration route can depend on the type of the complex wound and client condition. Consultations with surgeons, pain management specialists, wound care nurses, and other specialists also can be considered for pain management for clients with complex wounds. While there is no set guideline for ever instance of a complex wound pain management situation, there are hundreds of pain management options approved by the FDA for their own clinical indications that can possibly be a good fit for a client given their health history and condition (1,2,3,14,18,19,20,21,22). 

What Are Some Side Effects and Complications of Pain Management Options? 

While pain management options are extremely common, such as opioids and NSAIDs, there are several possible complications to these options. Opioids, while extremely popular and effective for pain management, have severe serious side effects, such as several drug-drug interactions, respiratory depression, changes in heart rate, and constipation. Opioids also can trigger opioid dependence, a serious public health concern and growing health concern among many health care providers.  

While pain management is a goal for clients with complex wounds, assessing for any prior opioid dependency or increased risk of complications is essential. NSAIDs in high doses can lead to increased gastric concerns and bleeding problems. Acetaminophen can lead to increased fatigue and increased complications with opioid use. While pain management is important for clients with complex wounds, it is important to also be aware of risks of these medications. Monitoring for liver function, kidney function, bowel movements, respiratory health, and cardiac vital signs are essential when administering pain medications (1,2,3,14,18,19,20,21,22). 

The most immediate complication of pain management is an anaphylaxis reaction, in which the medication would need to be stopped immediately and emergency medical intervention would be needed. Other complications of pain medication administered via VI can include IV site infiltration, IV site swelling, IV tubing issues, and issues with IV insertion. Given the wide range of possible and severe side effects and complications of pharmacological pain management, careful monitoring of a client’s health and condition is essential. While some clients will have no symptoms initially, others can develop symptoms over time, especially if they have complex health histories or several medications being administered.  

It is essential to check with your facility’s protocol regarding frequency of assessments and monitoring for clients receiving pain management. Furthermore, non-pharmacological interventions, while proven to be effective, can have inadequate pain management responses, causing delayed wound healing and care (1,2,3,14,18,19,20,21,22). 

What is the Average Cost for Pain Management? 

Cost for pain management options for complex wounds can significantly vary depending on the type of pain medication administered, concentration, dosage, frequency, client age, insurance, duration, and other factors. Pain management is often an expensive medical intervention, but for many clients, it is essential care and possibly the only way for some clients to improve their health and quality of life given their health situation. Cost is among a leading reason why many clients cannot maintain their medication and health care regime, especially if pharmacological and non-pharmacological pain management options are recommended in an outpatient setting. If cost is a concern for your client, consider reaching out to your local client care teams to find cost effective solutions for your clients (1,12,22,23).  

How Can Clients Self-Manage Pain Management Options for Complex Wounds? 

Depending on the nature of the complex wound, many clients might consider self-managing a complex wound before accessing health care services. On the other hand, clients might have been receiving care for a complex wound in health care, be discharged from a facility, and then are left to self-manage their care at their own discretion. Because of the varied situations people have complex wounds and varied access to health care, clients can self-manage their complex wounds with prescribed pain medications, non-pharmacological interventions, or OTC medications. While clients in acute settings monitored by nurses and other health care professionals do not need to self-manage their responses to pain management therapy, clients can be aware of possible pain management complications regardless of their setting.  

Clients can be aware of possible symptoms to alert for medical attention, such as trouble breathing, chest pain, facial pain, confusion, headache, numbness, redness around the IV insertion site, debris in the tubing, and fatigue. Caregivers or loved ones can be made aware of pain medication administration, benefits, and risks as well. Common ways for clients receiving pain management for complex wounds to self-manage themselves include having access to medical care in the event of a delayed allergic reaction, having follow up appointments scheduled with their health care providers, and having a support system. Clients and caregivers can also be educated on infection reduction techniques, such as hand washing, mask wearing, disinfecting surfaces, and more (1,3,4,8,11,13,18,20,21,22).  

What Happens to Clients Who Do Not Have Access to Pain Management for Complex Wounds When Clinically Necessary?  

Depending on the nature of the client’s condition requiring pain management for complex wounds, clients who do not receive adequate pain management might experience a decline in their health or progression of more health complications. Complex wounds can vary widely, from a severe burn covering over half the body to a surgical site infection on the arm to a gunshot to the chest. Because of the severity of complex wounds and factors involved in wound health and pain management, clients who do not have access to pain management for complex wounds are often in a fatal situation. As a result, it is important to educate clients on the importance of consistency in their treatment regime and the risks and benefits of being on pain management for complex wounds in addition to prompt, evidence-based treatment (1,3,4,8,11,13,18,20,21,22). 

Pain Management and Complex Wounds’ Special Considerations for Specific Client Populations 

Given the wide range of uses for IVIG therapy and use in various client populations, there are special considerations to be aware of for clients of certain age groups or with certain health conditions.  

Pediatric Populations 

Pain management use for complex wounds among pediatric clients is becoming increasingly more common in pediatric care units across America. From neonates to adolescents, pediatric clients have their own unique set of pain management and complex wound care needs. For instance, burns, physical trauma, gunshots, pressure wounds, and more can affect the pediatric population, causing many health care providers and caregivers to wonder about next steps for pain management in this population. For instance, a neonate can receive opioid via IV if they are experiencing severe burns, but opioids can also cause respiratory depression, making the use of pain management in this population a double-edge sword. Furthermore, neonates cannot express themselves with words the ways an adolescent who had experienced a gunshot wound can. Weight, dosing, frequency, and client and caregiver education are all factors to consider when thinking of pain management options in this population.  

In addition, wound healing can greatly depend on the overall health of the client, any pre-existing health conditions, and wound severity. While there are several stances and guidelines on pain management and wound care for pediatric populations, there is still much discrepancy among consistent guidelines and evidence-based research on its usage and effectiveness in this population. Educating parents, caregivers, and family members about pain management and wound healing is essential, especially if the treatment and monitoring continue after hospital discharge. In fact, more hospitals and pediatric and neonatal critical care units are exploring the long-term effects of pain management and complex wound healing weeks after discharge to monitor for improvement and possibly delay or eliminate the need for surgery or more aggressive treatment options (1,2,3,10,11,18,24,25).  

Medication administration in pediatric clients also needs to be monitored very carefully, as children and infants in particular use much smaller doses, concentrations, needle sizes, infusion pumps, and monitoring parameters. The exact prevalence of pediatric clients with complex wounds and who receive pain management is not known, as there are several instances of complex wounds among pediatric clients that are not captured in documentation and health care records. Unlike adult populations, neonates and children are unable to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to neonates receiving pain management.  

The use of blankets, pain medications, skin-to-skin care, music therapy, breastmilk or formula, dim lighting, and other interventions can be used when neonates are receiving IVIG therapy. Taking the time to educate and inform parents about these interventions is essential. Assessing neonatal and pediatric pain by examining for grimacing, excessive crying, skin changing, and other factors every hour is essential when giving pain medication. Because of the various differences in organ development and acute monitoring needing for pain management for complex wounds in pediatric clients, this is a special population that requires a good eye to detail, clear documentation, and excellent client care (1,2,3,10,11,18,24,25). 

Pregnant Populations 

Pregnant people experience complex wounds, and pain management among pregnant people remains a significant concern, as many medications can affect the fetus and pass-through breastmilk. Complex wounds in pregnancy can pose a serious risk to the pregnant person and the infant and can led to fatal complications if not adequately treated. While there are some guidelines for pain management options use during pregnancy or during the postpartum or breastfeeding time frame, much discussion remains about the use of complex wound management in pregnancy. In fact, there are several inconsistencies in complex wound management during this time, often leaving providers at their own clinical discretion based on resources and client situation.  

For instance, a pregnant person could be in a car accident, and at 35 weeks pregnant, this person might have burns on over 20% of their body. As a result, while an emergency C-section can be an option, complex wound management depending on the severity and location of the burns can affect the fetus, infant development, breastmilk production, and parent-infant bonding. The lack of complex wound management and pain management in this population leaves more questions than answers, leading many providers to seek information on expert opinions from obstetricians, maternal-fetal specialists, gynecologists, pain management specialists, and wound care specialists. The exact prevalence of pregnant clients who have received pain management or who experience complex wounds is not known. Like all other clients, they must be assessed prior to pain management use to determine the need, extent, duration, frequency, dosage, and strength (1,2,3,10,11,18,26,27).  

Geriatric Populations 

The geriatric population is one of the largest growing client populations in America and is continued to increase with the rise of America’s aging population. In addition, the geriatric population has some of the highest rates of complex wounds as a result of their immunocompromised status, often complex medical history, increased risk of falls and physical injury, and medication use. Because of their decreased skin integrity, possible increased mobility issues, and polypharmacy concerns, pain management and complex wound considerations in the geriatric population is a growing concern in health and among evidence-based research guidelines. Complex wounds in this population can pose a serious risk and increase risk of infection and further health compromise and can led to fatal complications if not adequately treated.  

While there are some guidelines for pain management options use among the geriatric population, much discussion remains about the role of complex wound management. In fact, there are several inconsistencies in complex wound management during this time, often leaving providers at their own clinical discretion based on resources and client situation. For instance, an 84-year-old client might be admitted to the emergency room for a fall from a flight of stairs on their hip, and this client also has a history of uncontrolled hypertension, diabetes melilites Type II, and arthritis.  

Another client might be a 90-year-old client in a long-term care facility that has mobility issues and has not been moved in their bed for almost a week as a result of staffing and documentation issues, leading them to have a pressure wound that is not healing adequately. The exact prevalence of geriatric clients who have received pain management or who experience complex wounds is not known, but it is estimated that thousands, if not millions, of geriatric clients will experience some sort of complex wound in their lifetime. Like all other clients, clients must be assessed prior to pain management use to determine the need, extent, duration, frequency, dosage, and strength (1,2,3,10,11,18,26,28,29,30). 

Complex Wound and Pain Management Complications 

When thinking about pain management and complex wound management, it is important as a nurse to be aware of the basics of both complex wound and pain management and possible complications of both. There are various pain medication formulas, doses, concentrations, and frequencies to be aware of. Like any IV medication, it is important to confirm the correct medication for the correct client at the correct dosage and time. It is also important to ensure patent IV access prior to administration of any medication and to monitor the IV site for any infection, bruising, discomfort, or infiltration. It is important to know if the medication therapy needs to be given via an infusion pump or set to drip at a certain rate.  

It is also important to be aware of any client allergies, other medication use, and pre-existing health conditions as well. Ensuring that you have all your equipment set up and IV protocol in place is essential for IV therapy administration. If clients are not receiving IV medications, it is important to make sure the patch is placed appropriately, that the pills are swallowed or ingested entirely, and that injections are administered in an appropriate way. Wound dressings need to be regularly changed, and documentation for these encounters need to be noted and kept up to date. If a client experiences complex wound or pain management complications, it is recommended to call the charge or lead nurse for further guidance and let the provider know immediately. If there is an extreme emergency, calling a code is always an option (1,2,3,4,5,6,7,8,9,11,17,18,19,21). 

Role of Telemonitoring in Inpatient and Outpatient Pain and Wound Care Management 

With the rise of at home client care, telehealth, and remote client monitoring, several clients receive pain management and complex wound care in health care settings and then transition to home use. While telemonitoring has expanded significantly in the past decade as a result of the rise of telehealth nursing, technological advances, and more widespread insurance and Internet coverage, making sure clients are aware of the risks and benefits of pain management options and complications from complex wounds are essential to nursing care. While clients receiving pain management and complex wound care at home should routinely seek advice and guidance from their medical care provider, many times, clients and caregivers can self-monitor their reactions to medical interventions for emergent complications or inadequate treatment resolution.  

Clients should be aware that if they suspect any complications with their pain management plan, such as trouble breathing, increased pain or discomfort, or chest pain, that they should tell the nurse immediately. Even though there are many possible complications from pharmacological pain management options, many clients report high levels of satisfaction with remote monitoring, such as more independence in their daily activities and less time in transit to medical appointments. Furthermore, many instances of physical therapy, nerve stimulation, and other non-pharmacological pain management options can be done in outpatient settings or at home (1,2,3,6,29,30).  

Nursing Considerations 

What Is the Nurses’ Role in Pain Management and Complex Wound Care Client Education and Management? 

Nurses remain the most trusted profession for a reason, and nurses are often pillars of client care in several health care settings. Clients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in pain management or complex wound client education, administration, and management, here are some suggestions to provide quality care for clients receiving pain management for their complex wounds (1,2,3,4,11,12,13,15,27,28,29,30). 

• Take a detailed health history of the client. Often times, vital signs and history taking can be complex, especially in acute settings. Many times, pain management and wound care are started in acute settings and then transitioned to home use or less-acute settings if needed. As nurses, it is important to be involved in the vital signs and history taking process to learn about noticing any abnormalities or medical concerns that warrant medical attention. As nurses, we are aware that complications from IV placements can lead to rapid fluctuations in vital signs, such as respiratory rate and oxygenation levels, and IV filtration. Also, it is important to assess the client for any skin changes or mobility concerns that can increase the risk of a complex wound development or make an existing wound worse. If a client is complaining of symptoms that could be related to a wound, such as burning of the skin, numbness, or dry skin, inquire more about that complaint.  
• Clearly ask the client if they have any allergies, especially to certain adhesives or medications. Pain medications can be derived from various sources, making them possible to trigger an allergic reaction. Monitor their skin integrity and breathing for any changes as well.  
• Educate the client and caregivers on pain medication administration and non-pharmacological interventions. Educate the client to inform the nurse of any redness, pain, or swelling. Take time to answer any questions about the therapies and to confirm the orders as well. 
• Regardless of how long a client has been on receiving treatment for a wound, if the client complains of any new symptom, ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a client’s complaint is not being taken seriously by other health care professionals, advocate for that client to the best of your abilities.  
• Review medication history at every encounter. Often times, in busy clinical settings, reviewing health records can be overwhelming, especially for clients with a complex medical history. Several clients taking pain medications have a complex medical history. Millions of people take medications for various reasons, and people’s medication histories can look similar over time. Ask each client about how they are feeling on the medication, how they are feeling with their wound, if their symptoms are improving, and if there are any changes to medication history.  
• Be willing to answer questions about wound care and pain management. There are many people who do not know about the side effects, risk factors to be aware of, and lifestyle changes that can influence outpatient care and wound healing. Be willing to be honest with yourself about your comfort level discussing topics and providing education on pain medication and complex wound care. 
• Communicate the care plan to other staff involved for continuity of care. For several clients, especially for clients with complex wounds receiving pain management, care often involves a team of nurses, specialists, pharmacies, caregivers, and more. Ensure that clients’ records are up to date for ease in record sharing and continuity of care. 
• Stay up to date on continuing education related to complex wounds and pain management, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other health care professionals and educate your clients with the latest information.   
• Educate the client on the importance of infection prevention, such as washing hands regularly, wearing a mask often, and other infection prevention measures.  

How can nurses identify if someone needs more intervention for their wound care and pain management administration and care?  

Unfortunately, it is not possible to look at someone with the naked eye and determine if they are receiving pain medications or have a complex wound. For many clients, complex wounds can be on their buttocks, pain, or legs, parts of the body that are often not initially visible in client care, especially for people with immobility or mobility issues. While some people might have notable complications, such as oozing fluids onto their clothing or sheets, trouble breathing, or sharp headaches, the most common presentation for complex wounds or pain management complications vary widely. In addition, nurses can answer questions and concerns regarding complex wounds and pain management for both clients and their caregivers. Nurses can provide quality care by completing health history, listening to client’s concerns, addressing caregiver’s concerns, and performing pain medication administration and complex wound care  (1,2,3,25,26,27,28,29,30). 

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors) 
• Tell the health care provider of any existing lifestyle concerns, such as alcohol use, other drug use, sleep habits, diet, surgical history, and allergies (need to identify lifestyle factors that can influence wound healing and medication and other medical interventions) 
• Tell the health care provider if you have any changes to your body, such as pain with breathing, trouble with movement, changes in urinary habits, changes in bowel habits, changes in sleep habits, or increased fatigue (potential systemic complex wound or pain management complication symptoms) 
• Tell the nurse of health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life, especially if pain or discomfort is near the IV placement site or wound site 
• Keep track of your health, medication use, machine function, and health concerns via an app, diary, or journal (self-monitoring for any changes) 
• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries 
• Tell the health care provider if you notice any changes while receiving pain management therapy (potential worsening or improving health situation)  

Research Findings 

What Research on pain management for complex wounds use exists presently? 

There is extensive publicly available literature on pain management and complex wound care via the National Institutes of Health (NIH) and other evidence-based journals.  

What are some ways for people who have experienced complex wounds to become a part of research? 

If a client is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and health care organizations. 

Case Study 

Wendy is a single mom to a 4-year-old living in a major USA city. Wendy works as an accountant and her child, Bobby, is in pre-school. Wendy receives a call from the pre-school that there was a fire, and some children, including Bobby, have been transferred to the local pediatric hospital. Wendy arrives at the hospital and see that Bobby has experienced second-degree burns on their left arm and torso area. Wendy is very emotional, upset, crying, and wants to speak to a health care provider immediately.  

• What are some specific questions you’d want to ask Wendy about Bobby’s health? 
• What are some health history questions you’d want to highlight? 
• How would you perform an initial assessment on this client? 
• How does cost influence someone’s ability to access health care services? 
• How would burns affect a pediatric client compared to a geriatric client? 

Wendy explains that Bobby has a history of asthma and allergies to penicillin. She left his inhaler at home and does not remember the dosage of it. After some time in triage, he is transferred to the pediatric burn unit and sees their mom. Bobby cries when they see their mom and states that they are in a lot of pain. Wendy asks the nurses if there is anything they can do to relive the pain.  

• How would a nurse educate a parent in the hospital about burns and pain management options? 
• How would a nurse education a parent on pain management in a 4-year-old?  
• What are some contraindications for pain medications in a pediatric client? 
• What are some ways to assess for wound healing in children? 

Bobby has been in the pediatric burn unit for a few days now. Bobby has been on some opioid medication via IV and seems to be doing OK. Wendy talks to the health care team, and they state that Bobby will have to be monitored in the hospital for a few more days and then be discharged. Wendy is concerned about taking care of a child with burns at home. Wendy asks the care team about pain options for Bobby and when he can go home and resume normal activities. 

• What are some client education talking points you would discuss with Wendy about a child recovering from burns? 
• How would you monitor vital signs in a 4-year-old receiving opioids? 
• How would you monitor for an allergic reaction to medication in this client? 
• What sort of non-pharmacological interventions can be performed for him inpatient and outpatient to facilitate wound healing and pain management?  

Bobby is discharged from the pediatric hospital a few days after admittance. Wendy is instructed to bring him back after 3-5 days for a follow up consult with the burn unit specialist and therapist. Bobby is recommended to see a child psychologist given the nature of the burn and recommended rest, hydration, pain medication, and wound care. He is also given pain medication to take at home. Wendy has completed a wound care seminar with the hospital as well. Upon arrival for his initial follow-up, Bobby is noted to have some leaky discharge near the left forearm. Wendy believes it is a sign the forearm is healing.  

• What are some complications from second-degree burns? 
• What are the stages of wound healing? 
• How does wound healing from a burn differ from other types of wounds? 
• How would a psychologist be able to help with pain management in a child? 
• How would you further examine a wound site for infection or other possible complications? 
• What are some considerations for types of discharges from wounds to be aware of? 
• What are some infection prevention measures that can be in place for a child with burns? 
• What would be your next steps as a nurse with this client? 
• What would be your pharmacological and non-pharmacological recommendations presently? 
• What are some possible complications of suddenly stopping pain management therapy? 

Conclusion

Complex wounds are an unfortunate health complication that affects thousands of people daily. Use of pain management options to assist with complex wound healing often requires extensive medical care and follow-up. While pain management options can be life-saving for many clients, because of the risks, a serious overview of risks and benefits must be considered prior to starting pain management. Education and awareness of different pain management options and ways to manage complex wounds can influence the lives of many people in a healthy way.  

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