The symptom of pain with pressure ulcers: a review of the literature

Abstract

Although wound pain often is described as an important clinical factor by both patients and providers, pain associated with pressure ulcers is poorly understood. To assess the state of knowledge of pain with pressure ulcers, a systematic, integrative review of the literature was conducted to determine: 1) how pain is measured, 2) pain prevalence/incidence, and 3) factors associated with pressure ulcer pain. Bibliographic databases including MEDLINE (1966-2005), HealthSTAR (1975-2005), CINAHL (1982-2005), and seven others were searched using the terms decubitus ulcers, pressure ulcer, pressure sore, bed sore, and pain and then culled to English-language, clinical publications. Of the 417 articles recovered, 26 met the study inclusion criteria, six specifically identified pain prevalence (ranging from 37% and 100%), and none documented the incidence of pain in patients with pressure ulcers. Measurement tools used to assess pain included the Visual Analogue Scale, the Verbal Rating Scale, the Wong-Baker Facial Recognition Scale, the McGill Pain Questionnaire-Short Form, the Numerical Rating Scale, and the Present Pain Intensity scale. Pressure ulcer pain was described as a burning sensation and reported as both constant and transient. Contrary to often-held clinical opinion, the studies reviewed suggest that pain increases with pressure ulcer stage. Although a number of intrinsic and extrinsic factors were studied (eg, age, ulcer stage, and bed surfaces), no conclusions could be drawn from the available research. Because pain is an issue for individuals with pressure ulcers and may present a different profile than other sources of pain, pain assessment should become an integral part of pressure ulcer care and documented to guide pressure ulcer management.