Predictors for Acute Pain During Wound Dressing Changes

Stop bleeding. Close up of a medical dressing being pressed to the knee wound by a nice professional doctor while stopping bleeding
This study sought to identify predictors of severe pain during wound dressing change.

Type of wound dressing, resting pain, and expected pain were predictors for severe pain during wound dressing change, according to results of a cross-sectional study published in the journal Pain.

This study, conducted at the University of Iowa Hospitals and Clinics in 2015-2018, recruited patients undergoing a wound dressing change. Patients (N=459) were evaluated for pain (10-point scale), wound factors, opioid intake, and possible predictors of pain during dressing change. All patients had their dressing changed by the same Certified Wound, Ostomy, Nurse.

Patients were 51.0% women, 93.9% were White 50.5% were aged <60 years, 86.5% had an acute wound, and 85.8% had their wound for 90 days.

Stratified by low or moderate pain (0-7 points; n=318) and severe pain (8-10 points; n=127), predictors for severe pain included expected pain (area under the curve [AUC], 0.83; P <.0001), resting wound pain (AUC, 0.78; P =0.0000), opioid uptake (AUC, 0.67; P <.0001), type of dressing (AUC, 0.62; P =.0002), age (AUC, 0.61; P <.0001), duration of wound (AUC, 0.59; P <.0001), depression (AUC, 0.58; P =.0025), Pain Catastrophizing Scale (PCS; AUC, 0.57; P =.0270), opioid tolerance (AUC, 0.57; P =.0022), and ethnicity (AUC, 0.53; P =.0324).

These findings indicated that increased risk for severe pain during dressing change associated with Negative Pressure Wound Therapy (NPWT) with a nonadherent dressing (odds ratio [OR], 4.40), patients with higher oral morphine equivalents (OR, 4.38), NPWT without a nonadherent dressing (OR, 4.22), patients who used some oral opioids (OR, 3.14), those with more expected pain (OR, 2.77), patients who were non-White (OR, 2.47), aged <60 years (OR, 2.40), with higher opioid tolerance (OR, 2.09), an adherent dressing (OR, 2.08), higher resting wound pain (OR, 1.96), those with depression symptoms (OR, 1.91), and higher PCS scores (OR, 1.04).

In the final model, the only predictors which remained significant were expected pain intensity (P <.0001), resting pain intensity (P =.0026), and type of dressing (P =.0242) with an AUC of 0.823.

For dressing type, severe pain was more likely for NPWT without a nonadherent contact layer compared with nonadherent (OR, 3.62; P =.01) or adherent (OR, 3.05; P =.005) dressings.

This study may have been limited by the definition of severe pain and by grouping moderate levels of pain with low levels of pain, as moderate pain may also be problematic during dressing change.

This study was the first to identify predictors of severe pain during wound dressing change. These findings may be used develop methods for controlling pain during dressing change.


Gardner SE, Bae J, Ahmed BH, et al. A clinical tool to predict severe pain during wound dressing changes. Pain. Published online December 15, 2021. doi:10.1097/j.pain.0000000000002553