The authors describe pain associated with wounds as venous, neuropathic, inflammatory, and arterial. Selected characteristics are shown in the table below.

Type of Pain	Characteristics	Strategies for Relief
Venous on or around the wound, below the ankle	Burning, aching, tightness	Elevation and compression of the leg, walking
Neuropathic radiating down the leg	Sharp/shooting pain, “pins and needles” or electrical sensations	Stretching, sitting
Inflammatory in and around wound	Burning and pain around the wound	Cooling, occlusion
Arterial in the muscle distal to the lesion	Cramping and aching	Decrease activity and lower legs

Medications are also used for pain management with varying degrees and length of time for relief. Pain relieved by medications were reported to last only minutes to hours, while pain management with other therapies were reported to last longer in a third of the 117 spinal cord injury patients in one study. Reducing anxiety related to pain through discussion of the pain that may be experienced during therapy maintenance can improve patient confidence and management.

Analgesics, including patient controlled analgesia (PCA), can reduce pain and anxiety associated with pain anticipation. Several options and the pros and cons of each were reviewed with recommendations for the use of several types. Pain associated with dressing changes can be prevented, such as using dressings that don’t dry out and adhere to wounds.

Wound odor management can include reducing infections and associated exudates. The authors suggest that charcoal containing dressings and odor-masking agents only affect minimal odors for a short period of time. However, mention is made of cyclodextrin-containing dressings to reduce odor-causing lipids.

New products were discussed, including honey, lidocaine, and morphine/lidocaine dressings that have promising results to date. Negative pressure wound therapy (NPWT) or vacuum-assisted closure (VAC) for draining wounds can decrease the pain of dressing changes, but is less used in palliative care because reimbursement requires that results (reduction of size) are documented. NPWT is contraindicated in malignant wounds.

Summary:
This article outlines the integration of palliative care principles into wound management for palliative care patients. The authors note that wounds can heal, and an emphasis is placed on symptom management and wound improvement. The guidelines for wound management are appropriate for basic wound care, but should be tempered by the need to consider palliative care goals and patient comfort. Patient confidence and understanding of care is an important feature of choosing appropriate wound management procedures and products. Alternate methods and devices/products can be used to appropriately treat wounds and reduce the pain associated with both the wound and the treatments. Nutritional support was seen as essential in improving both outcomes and quality of life. The mnemonic SPECIAL can be used to remember how to integrate palliative care principles into successful wound management guidelines.