Pain relief in difficult wounds: a multimodal approach
Only 6% of severe pain associated with chronic wounds receive adequate pain relief, although 75% of these patients report intolerable painful condition. This clinical observation describe tolerability and effectiveness of strong opioids used in multimodal association in difficult wounds with moderate-severe pain. Five patients with severe pain by wounds were observed, in our Pain Center, evaluating NRS-score (0=no pain – 10=worst pain). At baseline visit (Vb), was introduced oxycodone CR or buprenorphine for continuous pain, was reported frequency and intensity of incident pain (BTP) and dressing wound pain, introduction of immediate-release agent (tramadol IR) and pregabalin for neuropathic component were established. During follow-up, NRS-score, increasing dose of oxycodone CR, doses of IR tramadol, frequency and intensity of BTP, onset and severity of side effects were recorded. Quality of life, hours of sleep, improvement of mood, easiness of debridement, tolerability of drug were also evaluated. The comparison of NRS-score showed a significant improvement; BTP-score indicates also a significant reduction. No significant side effects were reported. QoL and pain during wound dressing were improved. A multimodal approach is crucial strategy in pain control of difficult wounds. Opioids and adjuvants can synergistically relief pain, with improvement of QoL, excellent tolerability and patient’s compliance.
Keywords: chronic painful wound, opioids
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