May 2012 Editorial: By Dot Weir, RN, CWON, CWS

  The co-editor of Today's Wound Clinic discusses the recent SAWC Spring conference and issues related to pain management.   Many of us recently returned from SAWC Spring in Atlanta, and it definitely lived up to the expectations we all had!   The educational and scientific sessions were outstanding, the convention venue was spacious, the Georgia Aquarium was beautiful, and the networking opportunities were plentiful! The meeting lived up to the honor that the state of Georgia bestowed by proclaiming the month of April “Chronic Wound Care Month.” Please remember to save the dates of May 2-5, 2013 (SAWC Spring in Denver) and Sept. 12-14, 2012, (SAWC Fall in Baltimore). This meeting will feature a wound center track, so it’s a perfect, smaller (but growing!) meeting that offers the same quality education and networking we all look forward to.   The issue of Today’sWound Clinic that you’re reading focuses on an inescapable aspect of wound management — pain. Our patients present with pain at varying degrees and with varying tolerances, providing clinicians the challenge of objectively addressing pain within the limits of licensure, ethics, and conscience. We know that many of our patients have pain that they arrive with, and we unfortunately conduct mandatory procedures that could add to their pain. My significant bias is that we must believe our patients’ pain is what they say it is until proven otherwise, and that we have an obligation to mitigate additional pain to the extent possible while providing some means of pain management for the patient between clinic visits — whether prescribed by the physicians in the clinic, arranged through the patient’s primary care provider, or made available through referral to formal pain management.   From a procedural aspect, the use of topical or injectable anesthetics, depending on the degree of the procedure to be performed (eg, minor debridement versus major or tissue biopsy) is imperative. “Verbal” anesthetics such as “I’m almost done,” “It’s ok, it’s ok,” or “hang in there”are never effective and can undermine a patient’s trust as well as potentially cause them to not return for follow-up care due to the fear of pain. Developing a plan for pain management to be shared with patients during an initial visit can go a long way toward maintaining trust. Other helpful practices include outlining how pain will be managed, assuring that painful procedures will be in the patient’s control (and stopped if intolerable), and having the patient sign a pain “contract” to set realistic expectations and an understanding from the beginning.   To that end, we have some very informative articles in this issue covering diverse aspects of care and pain management. In “Decreasing Pain & Improving Quality of Life: Clinical Strategies for Chronic Wound Patients,” Kevin Y. Woo, PhD, RN, FAPWCA, discusses how to assess, measure, and monitor a patient’s pain in order to provide care accordingly. A collaborative article between myself and fellow TWC editorial board member Pamela G. Unger, BS, PT, CWS, and Joe McCulloch, PhD, PT, addresses wound bioburden and increasing colonization as a potential source of pain as well as topical modalities that reduce bioburden and potential for additional pain. Additionally, TWC editorial board member Pamela Scarborough, PT, DPT, MS, CDE, CWS, CEEAA, and colleague Luther C. Kloth PT, MS, FAPTA, CWS, FACCWS, feature an introspective look at electrical stimulation as a modality to facilitate wound healing. Our Clinician’s Report takes a peak at the ever-growing category of negative pressure wound therapy.   Wishing you all a wonderful spring and summer!   Dot Weir, RN, CWON, CWS, co-editor; dorothy.weir@hcahealthcare.com