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“Ouch! That hurts!”

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Wound pain can have a profound effect on a person’s life and is one of the most devastating aspects of living with a wound. In addition to pharmaceutical options, wound care clinicians should consider other key aspects of care that can alleviate pain. Here is a checklist to ensure you are thorough in your assessment.

Skin protection

✓   Offload bony prominences to reduce ischemic and traumatic pain.
✓   Use a bed cradle to lift the weight of bed linens off the patient’s hypersensitive areas.
✓   Use splinting to immobilize injured tissues.
✓   Use transfer-assist devices to reduce pain during transfers.
✓   Use lift sheets to avoid friction shear pain.
✓   Protect periwounds from maceration and epidermal striping by using skin sealants and moisture barriers.

Dressing changes

✓   When removing tape, pull the tape parallel to the skin, towards the dressing. Pull slowly and keep your hand low. If the tape is over hairy areas, remove it in the direction of hair growth.
✓   Minimize sensory stimulus; for example, decrease wound manipulation
✓   When possible, allow the patient to perform his or her own dressing changes.
✓   Schedule dressing changes when the patient is feeling best.
✓   Minimize the number of dressing changes.
✓   Soak dried dressings before trying to remove them.
✓   Avoid overpacking the wound with dressing. For tips on wound packing, watch the video “Clinical Wound Packing.”
✓   Use low-adhesive dressings.
✓   Line the wound with a low-adherent
liner to avoid trauma when removing the packing or foam.

Wound V.A.C.® considerations

A Wound Vacuum Assisted Closure (V.A.C.®) device can ease pain, but it’s important to care for it properly.
✓   Instill 10 to 30 mL of normal saline solution into the V.A.C.® tubing to soak underneath the foam. Let the saline solution sit for 15 to 30 minutes before gently removing the dressing.
✓   Saline solution also can be injected directly into the foam while low vacuum is applied to the dressing. Clamp the tube once the saline solution starts to flow into the dressing tube. Wait 15 to 30 minutes before gently removing the dressing.
✓   Cut the V.A.C.® sponge to the exact size of the wound. Avoid overlapping of the sponge onto good skin unless bridging is necessary to prevent skin maceration.
✓   If granulation tissue is growing into the sponge, increase the frequency of the dressing changes.
✓   Line the wound bed with a white, polyvinyl alcohol soft-foam sponge, a nonadherent oil-emulsion type dressing, a contact layer dressing, and a thin layer of amorphous hydrogel or calcium alginate before the gray sponge
application.

For more information, access “Wound V.A.C. dressing change” from U.C. Davis Health System.

Reduce edema

✓   Elevate legs to reduce edema-related pain.
✓   Use appropriate vascular compression wraps to control edema and reduce pain.

Complementary therapies

Consider using the following complementary therapies:
✓   Relaxation and massage therapy—These help reduce tension and anxiety, which can improve the patient’s pain tolerance by breaking the anxiety-pain cycle. Read more about relaxation techniques.
✓   Visualization and imagery—Focus the patient’s attention away from the painful stimulus by creating images that are
either consciously selected (visualization) or spontaneously occurring from the unconscious (imagery).
✓   Distraction—Use a specific physical stimulus, such as television, music, or conversation, to draw attention away from the pain.

Psychological/teaching

✓   Teach the patient and significant others about pain management and wound treatment plans.
✓   Evidence shows that how people think about pain can change their sensitivity to it along with their feelings and reactions, so try such tactics as holding the patient’s hand, offering reassurance, acknowledging the pain, explaining all
interventions, restoring a sense of self-control, and having the patient help with dressing changes by holding the dressing in place or cutting tape.
✓   Allow for breaks during painful procedures so the patient can rest.

Donna Sardina is Editor-in-Chief of Wound Care Advisor and cofounder of the Wound Care Education Institute in Plainfield, Illinois.

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32 Thoughts to ““Ouch! That hurts!””

  1. janetghall

    on the wound vac considerations, I’m not sure how to inject the saline with low suction involved. Once the seal is broken,the vacuum will not work correctly from what I have learned with the wound vac dressings. Please explain.

  2. Janet,
    You are correct, if seal is broken the suction will not work with negative pressure wound therapy. The saline recommendation is to be utilized for preventing/decreasing pain at dressing change. Hope that helps…

  3. Kristin

    I just had my vac changed for the first time although this is my second use of a vac, anyway. The initial set up did not hurt and I was happy. The change done today, hurts just sitting still. My pain level is increased from a one to a ten!! Is this normal?

    1. Kristin, This does not sound normal. You should contact your healthcare professional directly so they can review what is going on.

  4. Lisa

    How can something so painful hurt. My wound gets changed 3 days a week, the remainder days my anxiety about the changing is so high I am sick. Please explain to me how this wound vac is good fo me. I am post 28 surgeris and and a number of infections. I am sick of surgeries, being sick, and being away from my family. What makes this any better/different than what I have ever gone though. Please help. Tiered of the pain.

  5. Donna Sardina

    Lisa,
    WOW, I can almost feel your pain and frustration just by reading your post. There are several different methods that can be tried with the Wound V.A.C. to help decrease or even remove the pain. I encourage you to contact your health care clinician and request their help with alleviating the pain with your wound dressings. If they are not sure what to do, you or the clinicians can contact KCI directly for some assistance. Here is a link to the KCI website with contact info: http://www.kci1.com/cs/Satellite?c=Page&childpagename=KCI1%2FKCILayout&cid=1229624983976&p=1229538260457&packedargs=genarthead%3DContact%2BKCI%2Bfor%2BCustomer%2BSupport%26locale%3Den_US&pagename=KCI1Wrapper

  6. Judith Raley

    I, too, am expeeriencing great pain with the KCI wound Vac. I have a wound at the harvest area of a leg bypass surgery. My doctor seems indifferent to how painful these machines can be. Doctors and health care personnel can make all the difference in being able to tolerate these machines. They are so helpful but all healthcare personnel should have to wear one and having an uncaring person rip off the bandages a time or two to get the full drift of the psychological damage one can incur from the use of these machines. My doctor raised my settings on the machines 100%. He should have raised it gradually but he doesn’t have to endure the pain.

    1. Donna Sardina

      Judith,
      Thanks so much for sharing your thoughts. You are so right that healthcare professionals need to slow down and make sure that while trying to heal, that we are not causing more pain. 🙁

  7. Debbie

    KCL Wound VAC was applied but not started on my dad because not all the pieces were present. Dad was in excruciating pain. What was causing the pain?

  8. I’ve been the in nursing business for a while and its always different individual. Some wounds hurts more than others when placing the NPWT wound vac therapy pump on them. But if you have a good nurse around, they know to medicate the patient first and wait until the pain meds take into effect before moving forward with the dressing change or dressing and NPWT wound vac application.

  9. Ron Jaynes

    I get my wound vac on my calf changed three times a week. I take percocet before, but wonder if there is a less heavy pill that will help with the pain?

    1. Donna Sardina

      Ron,
      There are several different pain medication options that could be tried for you that are not as strong as percocet. I encourage you to contact your care provider and ask for their assistance in trying some different options. In addition here is a web link to several different government guidelines for pain management that you could share with your provider: http://www.guideline.gov/search/search.aspx?term=pain

  10. I just had a wound vac delivered and I am sick with the anticipation of having it applied tomorrow. I had one several years ago so I am very well aware of the pain involved. It always surprises me when providers order this therapy with what appears to be glee knowing full well the pain they are assigning to their patients. I read one study that says the proper use of the wound vac increases healing by approximately 15 days. I will spend all night tonight weighing the merits of 15 days quicker healing to days of misery and inconvenience .

  11. John

    My wound vac changes are scheduled one week apart. Is that normal? Just noticed some redness around the wound today (5th day).

  12. Molly Buller

    I followed a wound vac dressing change behind a nurse at a wound care clinic that packed 6 inches of foam into a 1.2 inch tunnel. The patient said the packing was very painful. Is that correct procceedure?

  13. Rick Capano

    I dropped a small freezer on my foot on June 29th 2014. I went to the hospital two days later because I started to get “blisters” on top of my foot. They did blood work and told me I had an infection called. Cellulitis. The blisters turned in much bigger wounds but with the antibiotics the infection went away. Not much pain after that but I developed “Compartment Syndrome” I had to have surgery to remove the dead Tissue. they put a wound Vac on after the Surgery and its been about 3 weeks now and it is healing great. BUT the pain from the changing of the Vacuum Sponge is unbearable and they do it every other day. IF you get this type of wound get the Wound VAC, no doubt but make sure you get plenty of pain pills for the dressing changes. Plus be prepared to lay in bed for weeks because you cannot walk from the Foot pain

  14. Alicia

    I would be remiss if I did not leave a post here. I am the caregiver for my mom who just had colon cancer removed and the wound vac system was prescribed. If I had only known the pain and anxiety level this would cause my mom after being through so much already, I would have told them absolutely not. We were told the benefits and how this is a better way to heal, etc. In reality, my mom’s anxiety level every other day when the wound bandage needs to be changed, and then the pain she is in while they are removing it, is barbaric. I was so happy to find this blog with the posts because I was questioning if my Mom was the only one going through this. You will find all the medical studies and information touting the benefits, but the reality of what the patient endures should tell the medical community they need to rethink how they treat patients who are in tremendous pain already. How can something that causes ongoing pain, stress and massive anxiety prior to multiple wound changes truly benefit a patient as they are recovering. It sounds counterintuitive to me.

    1. Donna Sardina

      Thanks for sharing your comments Alicia.

  15. Mary Y

    I’m glad to know that I’m not the only one with these feelings. The anxiety of knowing the dressing change is imminent is pure torture. I lose my appetite and get stomach aches. I take 2 pain pills each time but that doesn’t help with the drape being pulled off my skin. And my wound is in the pelvic area…need I say more? I wish I knew how much longer I had to have this thing. The Dr says it just depends on my healing. I am just to the point where I feel like I can’t handle one more second.

  16. Marshall L

    Just do yourself the favor and use wet to dry! The wound vac does speed up healing drastically, but hurts soo bad. Turning it off and letting water run on the stuck part in the shower helped a little. Take it off yourself if you can, although it can be the most piercing pain. Good luck to anyone that is going through this. Wet to dry will seriously be your best friend when they switch to that haha.

  17. Mansi Singh

    Wound vac is indeed a good option for faster healing but it is very painful when the sponge is pulled out of the wound. I had my lumpectomy done on 8th april 2015 and just after my 2nd chemo og AC?, there was a severe infection at my surgical site. Now after 2 weeks of NPWT vac dressing my oncosurgeon has suggested to close the wound. Small victory with lot of pain but scared of stiches now.

  18. LaTasha

    I am a Homehealth Field Staff Nurse and I have used wound vac of different manufactures for several years. I was wondering on a C-section line that dehisced wound that measures 1cml x 9cmw x 0.5cmd. NOW. when to stop treatment? per the wound vac company treatment should be dc’d.

  19. Loretta

    I am a retired nurse who during my career was head of the wound care team at my facility. I used wound vacs on numerous patients and as one post said we at times ordered these with “glee”. That glee was because we knew this treatment wound/could heal a wound faster then anything else we had to offer, have a better chance of healing with out complications such as infections which in our fragile patients could lead to death. We saw the wound vac as a life saving/extending benifit for our patients. We always used the utmost care during changes to be gentle, made sure patients were properly medicated and as positioned for comfort as possible. My drt now has a vac on her foot at home from a wound caused by stepping on a tack as a diabetic that cause her to have a large portion of her sole removed surgically. The wound was initially treated with wet to dry with visiting nurse appling one and and me doing a second. The wound looked great healing well. Once area between toes healed the vac was ordered and yes I was happy as felt would sped healing, decrease chance of infection and as she is a diabetic felt it was best for her. Sat. my grandson called me said something was wrong with the vac so I went to go see. She had called the home health nurse on call who told her to have someone remove the dressing as she couldn’t be bothered to come deal with it. I removed this to find a mess. Wound severly maceracted around wound to point lost tissue between toes and can see tunneling there, sponge was no where near cut to fit wound over lapped by good inch all across one side and bottom on wound but no sponge near end with toes, a good 0.5 cm undermining along edge of side and bottom that was over lapped with sponge. A white macerated mess. No alarms had gone off on the machine but there was a obvious leak as they had covered occlusive drsg with gauze kerlix and it was covered in blood under first few layers. She said someone had bumped her foot badly earlier in the day which I believed caused the bleeding. Grandson had called because machine didn’t sound the same, usually loud constantly when arrived buzzed intermitantly about every 2-3 min. Drt told me the two changes nurses did was extreme agony. That she was in so much pain could not stand it. Now I regret ever encouraging her to get this vac. Am currently waiting for visiting nurse to have her explain this mess and awaiting return call from MD to ask that this treatment be stopped.

  20. candace crosby

    I just had a c section two weeks ago and went back to the doctor for a pico womb vac for my incision last week. The girl that applied it was not my doctor but works there and was so rough applying it and even snagged one of my stitches while cleaning my incision which caused and still causes me pain in which I didn’t have at all before..I was supposed to go back two days later for them to check it but I was scared my doctor wouldn’t be there to check it and I get the same girl and be in more pain so I didn’t go. Tomorrow will be a week and I’m supposed to get it removed but been trying to call the office for an appointment and no answer or no reply when I leave a message..so here’s my question…can I just remove it myself since the tape is already almost off anyway with my husbands help of course and that way I can go at my own speed and not hurt as much because of someone else not caring or being careless..

  21. sonja tabbert

    I hah tripple heart surgery and after nurse home dis not properly care for wound. Dr decided to put wound wac on. Wound is healing but process is very slow. Especially since I am also diabetic. If nursing home would have properly took care of wound I would be healed by now.it has been 2 months plus.is it normal to have vomiting when vac is changed 3 times a week ???

  22. Leo K

    I have been on VAC treatment for a leg wound for the past 9 days. For the first six days I was in hospital on IV antibiotics. The antibiotics were discontinued three days ago.

    I have noticed that where the wound meets the foam, the flesh is a pinkish colour all round. Yesterday the visiting nurse said the wound looked very clean.

    Is the pinkish flesh all around the wound normal and likely to be just caused by the suction, or could it be a sign of infection?

    Thank you for any advice

  23. Joshua Wigginton

    I will be getting a wound VAC tomorrow. The wound in question is in a bad area, being on the upper part of the crack between my buttocks. I am worried about pain severely. I recently watched an online video of the application and changing of the dressing. It seems to me that those actions will be very painful. I am not sure what to expect. I’d there any advice as to minimizing pain? My doctor has assured me that it will not be painful only uncomfortable. That is the same thing I was told about a catheter. That itself hurt severely. Thanks.

  24. Ian Paice

    I had the “pleasure” of utilizing the wound vac for an inner thigh necrotizing faciitis post operative care in 2012. While the wound healed nicely, the pain was unbearable, until the outpatient wound care nurse suggested a 50-50 mixture of NS and lidocaine being applied to the dressing 15 mins prior to dressing change. Prior to this, 8mg of hydromorphone would not touch the pain from the dressing changes, of which I can only describe as 1 million tiny fishhooks being ripped from my flesh. By the second dressing change utilizing the lidocaine mixture, I was removing the sponge dressing on my own, with minimal nursing assistance until the replacement of the dressing and covering.

  25. Thomas

    I am extremely sick in my stomach that VAC isn’t working for my dad diabetic ulcer. His ulcer is just over a month and already debridement more than 10 times once qith jet and twice using operating room surgery. I guess next step is amputation.

  26. Gary Donahoo

    This is the second time I have had a KCI wound vac. I am a T-4 paraplegic and my wound is on my left buttock. The problem I am having is not pain from putting the VAC on or taking it off, I have excruciating burning pain after the VAC has been on for a while. When the VAC is put on I’m all right for 12 to sometimes 20 hours depending how many Percocet’s I take but after that the wound starts to burn so bad I cannot stand it and have to take the VAC off. They have my VAC scheduled for change every other day or two.
    I don’t know how to handle the pain I am going through. From what I have read this VAC is not supposed to hurt the way it does.
    Because of the pain I am going through my wound is not healing the way it’s supposed to. Anyone else have this type of pain with the Wound VAC if so how did they handle it or what changes were made to stop the pain?

  27. Susan

    I’ve had a wound vac for about a week and a half now. I have fortunately had no pain with it, although that is from the diabetic neuropathy in my foot. (I had my big toe removed.) I’ve had the dressing changed once, no problem. My concern is that some of the skin under the dressing is staying wet. It was wet when the dressing was removed, and as it was only off for twenty minutes or so that skin couldn’t really dry out. Right now I’m getting it changed once a week, as its an hour drive each way to the doctor’s office. I just don’t like that damp skin, but don’t see how to dry it with the wound vac on.

  28. stacia

    My dr recommended the vac well lets just say if i could turn back time there would be no way i would be going through this pain,, i had to have my inner thigh removed and just had my first dressing change ,, ive never experienced pain like that in my life,, i delivered twins vaginally and would do it twice a day compared to the pain associated with the vac. Im more stressed out about the dresssing chNge tomorrow all i can think is just sedate me. Am happy i found this site and reading everones comment tomorrow iam taking a shower and peeling that tape off myself and drenching the foam with saline solution ..

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