Reddy Madhuri, Kohr Rosemary, Queen Douglas, Keast David, Sibbald R Gary
Department of Medicine, University of Toronto, Division of Geriatric Medicine, Division of Dermatology, Sunnybrook and Women's Health Sciences Centre, Toronto, Canada.
Ostomy Wound Manage. 2003 Apr;49(4 Suppl):2-15.
Chronic wound pain is distressing and influences the patient's ability to function. One of the failures of modern medicine is the inadequate assessment and treatment of pain. The clinician's approach to chronic wound pain combines the "preparing the wound bed" paradigm with chronic wound pain models. A holistic approach must include the diagnosis and treatment of the underlying cause, identification and correction of patient-centered concerns, and the three major components of local wound care (debridement, bacterial balance/prolonged inflammation, and moisture balance). The Krasner pain model defines chronic (persistent), noncyclic acute, and cyclic acute wound pain. Chronic persistent wound pain without an event or trigger often relates to the cause of the wound that needs to be corrected to relieve the pain. Noncyclic acute pain is often experienced with a surgical procedure such as sharp debridement. Cyclical acute pain may occur repeatedly with removal or application of new local wound dressings. Securing a thorough pain history focusing on pain patterns will help healthcare professionals develop specific pain relief initiatives. Pain is a component of quality of life. Patient-centered concerns need to address pain control measures until the cause of the pain can be corrected. Controlling pain, however, may not always improve quality of life scores. Each of the components of local wound care also may be responsible for the production of pain; strategies need to be implemented to ensure adequate patient comfort.
慢性伤口疼痛令人痛苦，且会影响患者的功能。现代医学的一大不足在于对疼痛的评估和治疗不够充分。临床医生对慢性伤口疼痛的处理方法将“准备伤口床”模式与慢性伤口疼痛模型相结合。整体方法必须包括对潜在病因的诊断和治疗、识别并纠正以患者为中心的问题，以及局部伤口护理的三个主要方面（清创、细菌平衡/持续性炎症和水分平衡）。克拉斯纳疼痛模型定义了慢性（持续性）、非周期性急性和周期性急性伤口疼痛。无事件或诱因的慢性持续性伤口疼痛通常与伤口病因相关，需要对病因进行纠正以缓解疼痛。非周期性急性疼痛常出现在诸如锐性清创等外科手术过程中。周期性急性疼痛可能在更换或应用新的局部伤口敷料时反复出现。获取一份详尽的、聚焦于疼痛模式的疼痛病史，将有助于医护人员制定具体的疼痛缓解方案。疼痛是生活质量的一个组成部分。在疼痛病因得以纠正之前，以患者为中心的问题需要涉及疼痛控制措施。然而，控制疼痛并不总能提高生活质量评分。局部伤口护理的每个方面也可能导致疼痛；需要实施相应策略以确保患者充分舒适。
