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Lookup NU author(s): Dr Fiona Campbell, Dr Georgie WilkinsORCiD, Katie TwentymanORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Pain during dressing changes is a major concern for individuals with chronic wounds, such as venous leg ulcers, diabetic foot ulcers and pressure sores. These procedures, often performed in community settings, can cause significant physical and emotional distress. Despite widespread recognition of this issue, there has been no comprehensive synthesis of evidence to guide effective pain management strategies during dressing changes. Objective: This mixed-methods systematic review aimed to evaluate interventions designed to reduce pain during dressing changes for chronic wounds and to explore the experiences of patients and healthcare professionals. Methods: Twenty-nine studies were included: 8 effectiveness studies, 11 surveys and 10 qualitative studies. Data were sourced from six electronic databases and analysed using a convergent segregated approach. Quantitative data were summarised using synthesis without meta-analysis guidance, while qualitative and survey data were analysed thematically. Findings were integrated using the preventing pain at dressing change pathway, a framework developed with stakeholder input to map interventions across the dressing change process. Results: Pain was found to be highly variable and influenced by wound type, healing stage and previous experiences. Non-adhesive and ibuprofen-releasing foam dressings consistently reduced pain, while gauze dressings were frequently associated with increased discomfort. Topical treatments, such as eutectic mixture of local anaesthetics cream and morphine gel, showed promise. Patients valued skilled, communicative nursing care and involvement in their own treatment. Distraction techniques and post-dressing pain relief were identified as important but under-researched. Pain assessment practices were inconsistent, and formal tools were rarely used. Limitations: The broad scope of eligible interventions increases the risk of missing relevant studies. Most studies were small and at moderate to high risk of bias. Future work: Future research should focus on evaluating underused interventions (e.g. distraction, patient involvement), improving pain assessment practices, and addressing equity gaps in pain management. Investment in nurse training and consistent care protocols is essential. Conclusions: Effective pain management during dressing changes requires a holistic, patient-centred approach. While some interventions show promise, many commonly used strategies lack robust evidence. The preventing pain at dressing change pathway offers a practical framework for guiding future practice, research and policy development. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR131023.People living with chronic wounds – such as leg ulcers or pressure sores – often experience severe pain when their dressings are changed. This pain can affect their quality of life, cause anxiety and make it harder to continue with treatment. Despite this, there hasn’t been a clear understanding of what works best to reduce pain during dressing changes. This review looked at 29 studies from around the world to find out which methods help reduce pain. It included research from clinical trials, surveys and interviews with patients and nurses. The goal was to understand both what works and what people find helpful in real-life care. Some dressings, like those that do not stick to the wound or contain pain-relieving medicine (like ibuprofen), were shown to reduce pain. Others, like gauze dressings, often caused more pain. Using creams like eutectic mixture of local anaesthetics or morphine gel also helped in some cases. Patients said that having nurses who were gentle, skilled, and communicative made a big difference. Being involved in their own care – like helping remove the dressing – also helped reduce anxiety and pain. Distraction techniques, such as listening to music, were mentioned as helpful but haven’t been properly tested. Unfortunately, pain after the dressing is applied is often ignored, even though it can last for hours. Nurses do not always assess pain properly, and some patients worry about using painkillers too often. This review highlights the need for better training for nurses, more consistent care and further research into simple strategies – like using tap water for cleaning or involving family members – that could make a big difference.
Author(s): Campbell F, Wong R, Wilkins G, Wang M, Twentyman K, Cooper R, Kirkcaldy A
Publication type: Article
Publication status: Published
Journal: Health Technology Assessment
Year: 2026
Volume: 30
Issue: 59
Pages: 1-57
Print publication date: 01/08/2026
Acceptance date: 02/04/2018
Date deposited: 17/08/2026
ISSN (electronic): 2046-4924
Publisher: NIHR Journals Library
URL: https://doi.org/10.3310/GJRC0808
DOI: 10.3310/GJRC0808
Data Access Statement: Data extraction tables and search strategies are provided as supplementary tables or by reasonable request to the corresponding author.
PubMed id: 42573060
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