Pain relief strategies for dressing change in chronic wounds: a mixed-methods systematic review and survey of UK practice

RESEARCH QUESTIONS: For people living in the community with chronic wounds and experiencing pain at dressing change: i) What is the current evidence for strategies to relieve pain at dressing change? ii) What are the pain relief strategies currently used in UK practice and what are patients’, carers’ and healthcare professionals’ use and experience of these? iii) What are the requirements for an appropriate pain relief strategy, or strategies, which could be manualised, delivered and evaluated in the community?

BACKGROUND: Pain during dressing change has been reported as the worst part of living with chronic wounds. However, currently in the UK there is no clear guidance on how patients, carers and healthcare professionals should manage wound-related pain at dressing change and, while various strategies are employed in practice, there is a need to evaluate available evidence underpinning their efficacy.

AIMS AND OBJECTIVES: The aim of the research project is to determine what strategies are currently being used in the UK. The research will seek users’ opinions on their effectiveness, and explore which strategies could be manualised for use in the community and other UK settings. The objectives will be to:

1) Undertake a mixed methods systematic review of the quantitative evidence on interventions for pain prevention and alleviation at dressing change. Also, qualitative evidence reporting of experiences of patients, carers and healthcare professionals;

2) Undertake a survey of current practice in the UK to document what is being used or not used for a variety of chronic wounds

3) Examine systems and processes underpinning interventions, and where contextual factors may influence implementation and outcomes using a logic model to draw together the different data sources.

4) Identify pain relief strategies that could be manualised, delivered and evaluated in the UK community, and identify where evidence gaps exist.

METHODS: A mixed methods systematic review will be undertaken. A series of UK surveys of practitioners will be carried out, together with qualitative interviews with patients, healthcare professionals and carers in a sequential mixed methods design. A logic model will underpin exploration of intervention pathways across the data sources, in order to contextualise the review evidence and explore variation and consistency in current practice in order to recommend those strategies that could be manualised, delivered and evaluated in the UK community, and to identify evidence gaps to inform future research.

The work will be informed by stakeholder and patient and public involvement at all stages to ensure relevance and co-development of outputs. TIMELINES FOR DELIVERY: The project is currently planned to end at the end of September 2024.

ANTICIPATED IMPACT AND DISSEMINATION: The findings from this project will be shared with UK guideline developers and research funders to help inform clinical guidelines for pain management at dressing change of chronic wounds in the community and other UK settings; and identify evidence gaps for future research. Stakeholders will be involved in developing recommendations.

We will develop a dissemination plan to identify who needs to hear about the research and how we will achieve reach and impact.