Pain Management and anxiety intermingled in the minds of patients suffering from failed-to-heal wounds. The legendary saying is, “out of sight and out of mind.” Relating to the accuracy of the statement based on healthy, unwounded people in the world. However, in the special populations: of wound care clinics, nursing homes, and hospital facilities, anticipatory pain is a reality in the minds of patients who have experienced excruciating injuries. Fear orchestrates raw emotions associated with calamitous events’ injuries to the body (Fardin & Masumeh, 2020). Fear also creates future scenarios of horrific moments which have not happened (Fardin & Masumeh, 2020). Moreover, the anticipation of awful, painful experiences makes pain management reach a zero-improvement rate. How do we recalibrate the mind to be rational when it wants to think irrationally? Anxiety controls the effectiveness of pain management treatments, not vice versa.
What types of triggers or catastrophic events are responsible for developing anticipatory pain? There is substantial evidence that anticipatory pain exacerbates psychological distress and emotional distress from past calamitous events (Fardin & Masumeh, 2020). It does not always have to be physical trauma; it could also be emotional trauma such as childhood sexual assaults: molestation, rape, and incest with family members. Others have a history of verbal and physical abuse from intimate partner violence relationships from grade school to college. It is often more emotional discomfort than the physical pain patients exhibit relating to their chronic wound pain (Woo, 2010). The evidence has shown that 30% to 50% of the general population suffers from chronic wounds (Kutsuzaw et al., 2021). Another population of people, which makes up 70%, is experiencing persistent chronic pain (Kutsuzaw et al., 2021). The patients are at a high risk of experiencing depression, isolation, shame, anger, suicidal ideation, or at least suicidal thoughts because of the heaviness of emotional pain (Woo, 2010). As a result, many of them are refraining from participating or allowing the continuation of wound care treatments (Woo, 2010). Furthermore, evidence has shown that those patients who suffer from extreme anticipatory pain experience a higher level of discomfort during the treatments than other patients who practice distracted-based therapy and visualization practices before and during treatments (Anxiety Canada, 2019).
Let’s discover the type of therapy compared to patients suffering from chronic wounds and exhibiting anticipatory pain. Cognitive Behavior Therapy assists patients with a better quality of life and learns how to modify thinking to receive wound care treatments (Kutsuzaw et al., 2021). CBT is focused driven, which examines their maladaptive behaviors to find various solutions (Ankrow, 2021). Their maladaptive behaviors are likely developed from unhealthy and high-stressed environments. The main goal of CBT is to teach patients to recognize, examine, and make better decisions on how to respond to the constant triggers to stress (Kutsuzaw et al., 2021). CBTs that work well for chronic wound patients are guided imagery, distracted-based therapy, panic-focused psychotherapy, and writing as a self-awareness exercise (Ankrow, 2021). The techniques are designed to be slow-paced and deep-focused on panic attacks to understand better where these thought patterns originated (Ankrow, 2021).
Pain Management is a must for all treatments, especially in wound care. The administering of pain medicines before delivering wound care is a given. However, how do we healthcare professionals assist in subsiding emotional pain flares up? Practical, compassionate communication and open-ended questions are essential to understanding why patients respond? More practical, how can the professionals assist in preventing anticipatory pain?
Do not misunderstand that anticipatory pain is not always destructive in the proper context. Instead, it’s a defense mechanism to protect the body against potential danger and harm. In this blog, the discussion briefly explained how chronic and acute wound care patients respond in difficult times in preparing for treatments and difficulties continuing the process because of their psychological pain and emotional pain, which will exacerbate their low pain tolerance. We, as healthcare professionals, have to remember to deliver compassionate patient care and focused based education regarding emotional fragility toward wounds and wound care and keep learning the art of communication with our colleagues, our patients, and their caregivers.
The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.
Woo, K. Y. (2010). Wound-related pain: anxiety, stress and wound healing. Wounds UK, 6(4). https://doi.org/https://www.woundsme.com/uploads/resources/content_9692.pdf
Fardin, Soheila, A. R., & Masumeh, H. M. (2020). Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine, http://dx.doi.org/10.1016/j.ctim.2020.102341
Kutsuzawa, K., Taguchi, K., & Shimizu, E. (2021). Attention and Imagery in Cognitive-Behavioral Therapy for Chronic Pain: An Exploratory Study. Journal of Psychosocial Nursing & Mental Health Services, 1-10. http://dx.doi.org/10.3928/02793695-2021111
Anxiety Canada. (2019, March 6). Anticipatory anxiety. Anxiety Canada. Retrieved April 2, 2022, from https://www.anxietycanada.com/articles/anticipatory-anxiety/#
Ankrom, S. (2021, February 17). Top tips for coping with anticipatory anxiety. Verywell Mind. Retrieved April 2, 2022, from https://www.verywellmind.com/anticipatory-anxiety-and-panic-disorder-2584252