Interventions to reduce pain at dressing change of chronic wounds: a mixed methods systematic review
Abstract
Background
Pain during dressing changes is a major concern for individuals with chronic wounds, such as venous leg ulcers, diabetic foot ulcers, and pressure sores. These procedures, often performed in community settings, can cause significant physical and emotional distress. Despite widespread recognition of this issue, there has been no comprehensive synthesis of evidence to guide effective pain management strategies during dressing changes.
Objective
This mixed-methods systematic review aimed to evaluate interventions designed to reduce pain during dressing changes for chronic wounds and to explore the experiences of patients and healthcare professionals.
Methods
Twenty-nine studies were included: eight effectiveness studies, eleven surveys, and ten qualitative studies. Data were sourced from six electronic databases and analysed using a convergent segregated approach. Quantitative data were summarised using SWiM guidance, while qualitative and survey data were analysed thematically. Findings were integrated using the Preventing Pain at Dressing Change (PADC) pathway, a framework developed with stakeholder input to map interventions across the dressing change process.
Results
Pain was found to be highly variable and influenced by wound type, healing stage, and previous experiences. Non-adhesive and ibuprofen-releasing foam dressings consistently reduced pain, while gauze dressings were frequently associated with increased discomfort. Topical treatments such as EMLA cream and morphine gel showed promise. Patients valued skilled, communicative nursing care and involvement in their own treatment. Distraction techniques and post-dressing pain relief were identified as important but under-researched. Pain assessment practices were inconsistent, and formal tools were rarely used.
Limitations
The broad scope of eligible interventions increases the risk of missing relevant studies. Most studies were small and at moderate to high risk of bias.
Future Work
Future research should focus on evaluating underused interventions (e.g., distraction, patient involvement), improving pain assessment practices, and addressing equity gaps in pain management. Investment in nurse training and consistent care protocols is essential.
Conclusions
Effective pain management during dressing changes requires a holistic, patient-centred approach. While some interventions show promise, many commonly used strategies lack robust evidence. The PADC pathway offers a practical framework for guiding future practice, research, and policy development.
Registration: Prospero CRD42021260130
Funding statement: This work was supported by NIHR grant number: HTA NIHR 131023
Competing interests statement: None of the authors have any competing interests to declare.
Plain English Summary
Reducing Pain During Dressing Changes for Chronic Wounds
People living with chronic wounds—such as leg ulcers or pressure sores—often experience severe pain when their dressings are changed. This pain can affect their quality of life, cause anxiety, and make it harder to continue with treatment. Despite this, there hasn’t been a clear understanding of what works best to reduce pain during dressing changes.
This review looked at 29 studies from around the world to find out which methods help reduce pain. It included research from clinical trials, surveys, and interviews with patients and nurses. The goal was to understand both what works and what people find helpful in real-life care.
Some dressings, like those that don’t stick to the wound or contain pain-relieving medicine (like ibuprofen), were shown to reduce pain. Others, like gauze dressings, often caused more pain. Using creams like EMLA or morphine gel also helped in some cases.
Patients said that having nurses who were gentle, skilled, and communicative made a big difference. Being involved in their own care—like helping remove the dressing—also helped reduce anxiety and pain. Distraction techniques, such as listening to music, were mentioned as helpful, but haven’t been properly tested.
Unfortunately, pain after the dressing is applied is often ignored, even though it can last for hours. Nurses don’t always assess pain properly, and some patients worry about using painkillers too often.
This review highlights the need for better training for nurses, more consistent care, and further research into simple strategies—like using tap water for cleaning or involving family members— that could make a big difference.
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