PAIN DURING DRESSING CHANGES BASED ON THE ETIOLOGY OF SKIN ULCER

INTRODUCTION Pain associated with chronic skin ulcers, particularly during dressing changes, remains an underestimated issue. In recent decades, medical research has primarily focused on wound healing with the aim of improving the effectiveness of dressings and treatments and reducing the healing time. However, other important patient concerns, such as pain during treatment, have been largely overlooked. The 2004 EWMA Position Document was specifically developed to provide guidelines on how to assess and manage pain during dressing changes for chronic wounds. OBJECTIVE This master's thesis project aims to identify and compare the scientific evidence available in databases regarding this topic and to propose a training program for healthcare personnel, as well as the collection of clinical case data in the future within the Internal Medicine Department of the AOU San Luigi of Orbassano. RESULTS Patients with venous, arterial, mixed vascular lesions, and burns experience the most pain during dressing removal. Surgical wounds, on the other hand, tend to be the least painful. Pain-inducing procedures during dressing changes include touching the wound, cleaning the wound, applying a new dressing, and the waiting time before the procedure begins, which may trigger anticipatory psychological distress due to negative and painful memories of previous dressing changes. DISCUSSION The literature does not contain articles that clearly and significantly differentiate the level of pain between skin lesions of different etiologies. A few articles, although of little statistical value, indicate which types of skin lesions are more painful during dressing removal—findings that have been confirmed in the small clinical data collection conducted on Internal Medicine patients. CONCLUSIONS Nursing staff must be professionally competent, well-trained, and motivated to act in the patient's best interest. Currently, there is a large amount of information, methods, techniques, and materials available to help managing pain during dressing removal, which need to be utilized effectively. One positive outcome of this work has been the learning and training experience it provided to the Internal Medicine nursing team, helping them focus on the pain reported by the patient and the characteristics of the periwound skin when choosing treatments and dressings.