Stress and pain associated with dressing change in patients with chronic wounds

Objective: To assess pain and stress experienced by patients with chronic wounds at dressing change and to examine how this may be related to long-term chronic stress. Method: The study recruited 43 outpatients, with a mean age of 71.7 +/- 14.6 years. The sample included 18 male (42%) and 25 female (58%) patients from Wrexham and Salford (UK), all with chronic wounds that required frequent dressing changes. Physiological and psychological measurements of pain and stress, including numerical ratings (for stress and pain), heart rate, blood pressure, respiration rate, and a questionnaire survey of state and trait anxiety and of chronic stress were recorded at dressing change and in a control condition (at least 24 hours before/after dressing change during a period of rest). Results: Mean heart rate measurements were significantly higher at dressing change, while there was also a trend for higher numerical pain ratings, numerical stress ratings and state anxiety scores at this time. A significant, positive relationship was found between chronic stress and acute episodes of stress experienced at dressing change. Similarly, although not significant, a positive relationship was observed between chronic stress and acute pain reported at dressing change. Conclusion: This study provides a basis for understanding how increased acute pain and stress at dressing change may be related to chronic stress, which has been shown in the literature to contribute to delayed wound healing. The impact of these implications on cost of care and quality of life are also discussed.