Assessment of Persistent Pain in Chronic Lower Limb Wounds

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

Thesis with publications.

This thesis investigates barriers to the assessment of persistent pain in chronic lower limb wounds. A review of the relevant literature indicated that persistent woundrelated pain is either not managed or is under-treated by health care practitioners. Furthermore, no specific wound-related pain assessment tool exists to monitor this client cohort. Consequently a mixed methods study using an explanatory sequential design was conducted in three phases to explore contemporary practice in the assessment and management of wound-related pain based on the experiences of both clinicians and patients. The three phases were as follows: (i) a survey of health care practitionersto determine how and when wound-related pain is assessed, (ii) four focus groups of health care practitioners were conducted to explore their perceptions of the issues related to what influences the assessment and management of pain in chronic wounds and (iii) a survey of people with chronic lower limb wounds, to describe the psychosocial disturbances and the function of disability of patients with wound-related pain. The results showed inconsistency in the assessment of wound-related pain between health care practitioners. The perceived barriers to the assessment and management of wound pain were associated with institutional protocols and health care practitioners’ knowledge, beliefs and attitudes. People with chronic lower limb wounds employed negative coping strategies and attitudes towards their wound pain which was negatively associated with satisfaction with their wound treatment. This thesis supports the overarching problem of the lack of understanding by health care practitioners and clients of the importance of the management of persistent wound-related pain. Health care practitioners consistently reported that an increased emphasis should be given to this debilitating condition. There is an urgent need for the development of valid assessment tools and evidenced-based management strategies to address this serious defect in wound management practice.