Acute and chronic wounds can be a significant source of pain in advanced illness. Often wound pain is a combination of nociceptive or neuropathic pain.
- Nociceptive pain: Usually caused by damage to body tissue—decubitus ulcers, mucositis, and procedures (debridement, dressing changes, or radiation treatments). It is often described as sharp, aching, or throbbing.
- Neuropathic pain: Classically, chronic in nature due to long-term inflammation or injury to nerve fibers—certain malignant wounds or refractory mucositis. It is mostly described as burning, stabbing, or sharp.
Topical drug treatments
: Evidence supports the use of Eutectic Mixture of Local Anesthetics (EMLA) cream (a combination of lidocaine and prilocaine) for pain associated with dressing changes or debridement of a wound. The cream should be applied 20 minutes before the procedure to minimize discomfort; open wounds should be avoided.
: The effective use of topical ketamine as a gel, cream, ointment, or spray has been documented with few side effects at concentrations up to 20%. Often, it is compounded with baclofen, amitriptyline, or pregabalin.
Anti-inflammatory foam dressings
: They normally utilize diclofenac or ibuprofen as their active ingredient to inhibit synthesis of prostaglandins in body tissues and decrease proinflammatory cytokine activity.
: Its topical use has shown effectiveness for acute nociceptive and chronic neuropathic wound pain. Often, it is compounded with baclofen and gabapentin.
: Applying opioids topically to painful wounds has the theoretical advantage of offering a more localized effect with less systemic absorption and side effects. Morphine infused into a gel form is most frequently used in this method, but the use of topical methadone and buprenorphine has also been described. Morphine has also been utilized as a mouthwash to reduce mucositis pain.
: Topical aspirin, capsaicin, clonidine gel, and menthol have all been described to reduce wound pain, but evidence regarding safety and efficacy are lacking.
See reference for more information.
Adapted from Steele K. Topical treatments for acute and chronic wound pain. Palliative Care Network of Wisconsin. Fast facts and concepts #327. Internet. Available at https://www.mypcnow.org/fast-fact/topical-treatments-for-acute-and-chronic-wound-pain/. Accessed on June 18, 2021.