School of Nursing, Queen's University, Kingston, Ontario, Canada.
Curr Opin Support Palliat Care. 2013 Mar;7(1):86-94. doi: 10.1097/SPC.0b013e32835d7ed2.
Pain is a significant concern in people with chronic wounds. A systematized approach is recommended for the management of wound-associated pain with the objectives to address pain relief, increase function, and restore overall quality of life.
Combinations of pharmacological agents are often recommended based on varying degree of pain severity, coexisting nociceptive and neuropathic pain, and chronic inflammation related to wound-associated pain. Topical agents including morphine, tricyclic antidepressants (e.g., amitriptyline), nonsteroidal anti-inflammatory drugs (NSAIDs), capsaicin, ketamine, and lidocaine/prilocaine provide pain relief with minimal side effects. Mindful dressing selection to minimize trauma, handle excess fluid, and prevent periwound skin damage has been shown to reduce persistent wound pain. To avoid nocebo hyperalgesia, it is important to address emotions, anticipation or negative expectation of discomfort.
Pain is a complex biopsychosocial phenomenon that requires multiple pharmacological and nonpharmacological management approach.
疼痛是慢性伤口患者的一个主要关注点。建议采用系统的方法来管理与伤口相关的疼痛，目标是缓解疼痛、提高功能和恢复整体生活质量。
基于不同程度的疼痛严重程度、共存的伤害性和神经性疼痛以及与伤口相关疼痛相关的慢性炎症，通常推荐联合使用药物治疗。包括吗啡、三环类抗抑郁药（如阿米替林）、非甾体抗炎药（NSAIDs）、辣椒素、氯胺酮和利多卡因/丙胺卡因在内的局部治疗药物具有最小的副作用，可以缓解疼痛。有意识地选择敷料以尽量减少创伤、处理过多的液体和防止伤口周围皮肤损伤已被证明可以减轻持续性伤口疼痛。为了避免负面预期引起的痛觉过敏，重要的是要解决情绪、对不适的预期或负面预期。
疼痛是一种复杂的生物心理社会现象，需要采用多种药物和非药物管理方法。
