VIEW PDF - Wounds UK
VIEW PDF - Wounds UK VIEW PDF - Wounds UK
Clinical RESEARCH/AUDIToutpatient’s clinic for her finalassessment, by which point she wasno longer requiring analgesia andwas reporting no pain. Figures 3 and4 represent the overall changes inher SF-MPQ and VAS scores beforeand after using the dressing. Mrs Cwas able to go out for walks andcommented that Actiform Cool had‘made a world of difference to mylife. This dressing is marvellous’. Asignificant decrease in wound size wasobserved over the course of the audit,and Mrs C requested to stay on thedressing.Case study 3Clinical scenarioMrs H was a 71-year-old woman witha long-standing history of recurrentulceration to her feet and legs relatedto rheumatoid arthritis. The rheumatoidarthritis was being managed withazathioprine and prednisolone tablets.Mrs H had previously had arterial bypasssurgery to her right leg, and also sufferedwith heart disease and anaemia. Amonga large amount of other medication,she took modified release morphinesulphate tablets and paracetamol forgeneral pain relief.Clinical presentationMrs H presented to the outpatients’clinic with multiple ulcerations to herright and left medial malleoli, the gaiterregion of her right leg and a large ulcerto the dorsum of her left foot, whichwas noted to be particularly painful.This area measured 7.2 x 4.0cm with adepth of 0.3cm. The ulcer beds weresloughy and granulating, with staticwound edges. Surrounding skin waserythematous, oedematous and dryand flaky, with minimal to moderatelevels of exudate. Mrs H had acomplex history and had experiencedpain for many years.She was able to distinguish herulcer pain from the pain caused byher other disease. Mrs H completed aSF-MPQ which recorded severe painfor many descriptors, and she alsoadded stinging as another descriptor.The pain was affecting her sleep andmobility and she was unable to wearfootwear comfortably.Pre-Actiform CoolFigure 5. Change in VAS Score Pre- and Post- Actiform Cool in case study 3.Pain intensity(0=none, 1=mild, 2=moderate, 3=severe)ThrobbingShootingPre-Actiform CoolSharpCrampingGnawingHot-burningAchingTreatment outcomePain in the ulcer on the dorsumof her foot was identified as themain problem so it was decidedto apply Actiform Cool with theaim of reducing her ulcer pain.Due to Mrs H’s complex historyand co-morbidities, she regularlyattended clinic and so was monitoredmore frequently than other auditparticipants.Following one week of treatmentwith Actiform Cool, Mrs H reportedthat she felt the dressing had helpedwith her ulcer pain. She expressedthe pain as ‘sore’. The dressing wasbeing cut to the size of the wound toprevent maceration to the surroundingskin.Post-Actiform CoolHeavyPain descriptorsPost-Actiform CoolTenderSplittingTiringFigure 6. Change in SF-MPQ Results Pre- and Post- Actiform Cool in case study 3.SickeningFearfulPunishing/cruelOne week later, Mrs H felt the ulcerpain was much improved again, andstated her mobility was slightly improved.Her sleep remained disturbed, althoughshe felt this was not wholly related toher ulcer pain but also related to herrheumatoid arthritis generally.Mrs H stated on the final assessmentvisit that although she continued toexperience pain, overall the dressing haddefinitely helped, which is highlightedin Figures 5 and 6. The pain was alsobetter in the left leg where all theulcers were being treated with ActiformCool, compared to the right leg whichhad continued with non-adherentdressings. Of particular interest is thatMrs H reported that she was no longertaking her morphine tablets since using28 Wounds UK, 2008, Vol 4, No 3
Pain intensity(0=none, 1=mild, 2=moderate, 3=severe)Clinical RESEARCH/AUDITActiform Cool, and was now managingon paracetamol taken intermittently,which is a significant decrease in typeand frequency of analgesia.The dimensions of the ulcer tothe dorsum of the left foot remainedthe same, although the ulcer appearedslightly shallower and there was healthygranulation tissue evident at the base.Overall, the Actiform Cool dressingshad a very positive effect on Mrs H’spain experience, which was highlightedboth by her comments, the outcomes ofthe SF-MPQ pain assessments and thediscontinuation of morphine analgesia.Mrs H requested to continue with thedressings on completion of the audit.Case study 4Clinical scenarioMr J is a 55-year-old male with a threeyearhistory of venous ulceration. Dueto the pain in his ulcer he took regularibuprofen, in addition to a beta-blockerto treat hypertension.Clinical presentationMr J presented with a venous leg ulcerover the left medial malleolus. The ulcerhad developed initially from a traumaticinjury. On initial wound assessment,the wound bed was granulating withevidence of slough. The wound edge wasepithelialising with signs of erythema,oedema and haemosiderin staining tothe surrounding skin. Wound exudatelevels were minimal.An initial pain assessment using theSF-MPQ was performed, which indicatedthe wound pain was of moderateseverity but was tolerable with hisanalgesia. The pain from the ulcer did notaffect his sleep pattern or his activitiesof daily living. Mr J had to work full-timedespite being in pain from his ulcer.Treatment outcomeAfter two weeks of using ActiformCool as a primary dressing, assessmentscaptured an improvement in pain levels.Mr J commented that he had reducedhis analgesia and was now taking onlyone ibuprofen in the morning. Whenusing the SF-MPQ to describe theulcer-related pain, the severity was nowPre-Actiform CoolFigure 7. Change in VAS Score Pre- and Post- Actiform Cool in case study 4.ThrobbingShootingPre-Actiform CoolSharpCrampingGnawingHot-burningAchingreduced to mild. Figures 7 and 8 indicatethe reduction in pain levels recordedduring the audit period. The ulcer almosthealed during the audit period, andwent on to completely heal within a fewweeks of completion.DiscussionThe overall outcome of the auditreinforces the belief that ActiformCool has the potential to reducepain in some patients when used aspart of an overall pain managementtreatment plan. Although the dressingwas not successful in every case andthe results of the changes in pain levelsfrom the SF-MPQ were not statisticallysignificant, it was still considered asuccessful outcome by those patientswhose pain decreased. Although aPost-Actiform CoolHeavyPain descriptorsPost-Actiform CoolTenderSplittingTiringFigure 8. Change in SF-MPQ Results Pre- and Post-Actiform Cool in case study 4.SickeningFearfulPunishing/cruelvalidated pain assessment tool wasused, on occasions the results of thiswere not always consistent with thepatient’s self-reports, which makes theresults of an audit such as this difficultto fully interpret based on statisticalevidence alone. Consideration needs tobe given to the fact that many of thesepatients have both complex woundand general medical problems that caninfluence outcomes and make themdifficult to predict. It should also beacknowledged that other treatmentssuch as compression, which wereutilised alongside Actiform Cool, andthe short period of time over which thedressing was assessed, make it difficultto conclude that the use of ActiformCool was the only factor contributingto pain reduction.Wounds UK, 2008, Vol 4, No 329
- Page 1 and 2: Clinical RESEARCH/AUDITMeasuring ou
- Page 5: Pain intensity(0=none, 1=mild, 2=mo
- Page 9: Clinical RESEARCH/AUDITof compressi
Clinical RESEARCH/AUDIToutpatient’s clinic for her finalassessment, by which point she wasno longer requiring analgesia andwas reporting no pain. Figures 3 and4 represent the overall changes inher SF-MPQ and VAS scores beforeand after using the dressing. Mrs Cwas able to go out for walks andcommented that Actiform Cool had‘made a world of difference to mylife. This dressing is marvellous’. Asignificant decrease in wound size wasobserved over the course of the audit,and Mrs C requested to stay on thedressing.Case study 3Clinical scenarioMrs H was a 71-year-old woman witha long-standing history of recurrentulceration to her feet and legs relatedto rheumatoid arthritis. The rheumatoidarthritis was being managed withazathioprine and prednisolone tablets.Mrs H had previously had arterial bypasssurgery to her right leg, and also sufferedwith heart disease and anaemia. Amonga large amount of other medication,she took modified release morphinesulphate tablets and paracetamol forgeneral pain relief.Clinical presentationMrs H presented to the outpatients’clinic with multiple ulcerations to herright and left medial malleoli, the gaiterregion of her right leg and a large ulcerto the dorsum of her left foot, whichwas noted to be particularly painful.This area measured 7.2 x 4.0cm with adepth of 0.3cm. The ulcer beds weresloughy and granulating, with staticwound edges. Surrounding skin waserythematous, oedematous and dryand flaky, with minimal to moderatelevels of exudate. Mrs H had acomplex history and had experiencedpain for many years.She was able to distinguish herulcer pain from the pain caused byher other disease. Mrs H completed aSF-MPQ which recorded severe painfor many descriptors, and she alsoadded stinging as another descriptor.The pain was affecting her sleep andmobility and she was unable to wearfootwear comfortably.Pre-Actiform CoolFigure 5. Change in VAS Score Pre- and Post- Actiform Cool in case study 3.Pain intensity(0=none, 1=mild, 2=moderate, 3=severe)ThrobbingShootingPre-Actiform CoolSharpCrampingGnawingHot-burningAchingTreatment outcomePain in the ulcer on the dorsumof her foot was identified as themain problem so it was decidedto apply Actiform Cool with theaim of reducing her ulcer pain.Due to Mrs H’s complex historyand co-morbidities, she regularlyattended clinic and so was monitoredmore frequently than other auditparticipants.Following one week of treatmentwith Actiform Cool, Mrs H reportedthat she felt the dressing had helpedwith her ulcer pain. She expressedthe pain as ‘sore’. The dressing wasbeing cut to the size of the wound toprevent maceration to the surroundingskin.Post-Actiform CoolHeavyPain descriptorsPost-Actiform CoolTenderSplittingTiringFigure 6. Change in SF-MPQ Results Pre- and Post- Actiform Cool in case study 3.SickeningFearfulPunishing/cruelOne week later, Mrs H felt the ulcerpain was much improved again, andstated her mobility was slightly improved.Her sleep remained disturbed, althoughshe felt this was not wholly related toher ulcer pain but also related to herrheumatoid arthritis generally.Mrs H stated on the final assessmentvisit that although she continued toexperience pain, overall the dressing haddefinitely helped, which is highlightedin Figures 5 and 6. The pain was alsobetter in the left leg where all theulcers were being treated with ActiformCool, compared to the right leg whichhad continued with non-adherentdressings. Of particular interest is thatMrs H reported that she was no longertaking her morphine tablets since using28 <strong>Wounds</strong> <strong>UK</strong>, 2008, Vol 4, No 3
Change language