How should I manage pain and infection in patients with chronic wounds?

Management of pain and infection in patients with chronic wounds involves a multifaceted approach tailored to the wound type and clinical signs.

Infection management: Systemic antibiotics should only be offered if there is clinical evidence of infection such as spreading cellulitis, systemic sepsis, or underlying osteomyelitis, not based solely on positive wound cultures ¹. The choice of antibiotic should be guided by local microbiology advice to ensure effectiveness against local strains ¹. Topical antiseptics and antimicrobials are not routinely recommended for pressure ulcers ¹. For surgical wounds healing by secondary intention, appropriate interactive dressings should be used, and systemic antibiotics given if surgical site infection is suspected, considering local resistance patterns ².

Pain management and wound care: Dressings should be selected in discussion with the patient (and carers if appropriate), considering pain, tolerance, ulcer position, exudate amount, and dressing change frequency ¹. Dressings that promote a warm, moist wound healing environment are preferred for category 2 to 4 pressure ulcers ¹. Gauze dressings should be avoided ¹. Offloading pressure, especially for heel ulcers, is important to reduce pain and promote healing ¹,³.

Debridement: Assess the need for debridement considering necrotic tissue, ulcer size, and patient tolerance. Autolytic debridement with appropriate dressings is preferred; sharp debridement may be considered if quicker healing is needed ¹. Larval therapy is reserved for cases where sharp debridement is contraindicated ¹.

Additional considerations: Nutritional assessment and supplementation should be offered if nutritional deficiency is present, as adequate nutrition supports wound healing and may reduce pain ¹. Negative pressure wound therapy is not routinely recommended but may be used to reduce dressing changes in wounds with heavy exudate ¹.