Wound Pain Management: The Present and the Future
Article information
Abstract
Wound pain is a common issue during wound care procedures such as dressing changes and debridement, significantly affecting patient comfort and recovery. Effective pain management is essential, not only for enhancing quality of life but also for promoting healing and minimizing complications. Factors like resting pain intensity, expected pain, and type of dressing have been identified as key predictors of severe wound pain during these procedures, helping clinicians manage pain more effectively by enabling early intervention. The Wound Pain Management Model was developed to guide healthcare professionals in managing chronic wound pain through steps like wound assessment, local treatment, and systemic management when necessary. While opioids are a common treatment, concerns over dependence and side effects have led to the exploration of alternatives. Virtual reality (VR) has emerged as a promising non-pharmacological approach, reducing pain through distraction, particularly in burn and chronic wound care. However, variability in study designs limits the current understanding of VR’s overall effectiveness. This review examines both pharmacological and non-pharmacological approaches to wound pain management, with a focus on VR. Further research with larger, more consistent studies is needed to better assess VR’s long-term benefits across different patient groups and wound types.
Introduction
Wound pain is a prevalent issue for many individuals undergoing treatment for both acute and chronic wounds. Wound care procedures (WCPs), such as cleaning, dressing changes, and debridement, are crucial for promoting wound healing but often cause considerable pain and discomfort [1]. Studies indicate that dressing changes result in moderate to severe pain in approximately 74% of patients, with nearly 36% experiencing severe pain during the procedure [2]. If wound pain is not adequately managed, it can lead to complications such as anxiety, depression, and increased pain sensitivity, which can complicate future treatments. Additionally, unmanaged pain can trigger a stress response that impairs immune function, potentially delaying wound healing and increasing the risk of infection, leading to longer hospital stays and higher healthcare costs [3]. Therefore, effective pain management is essential not only for patient comfort but also for positive clinical outcomes.
According to the gate control theory of pain, the brain plays a critical role in modulating pain perception through neural mechanisms in the spinal cord and psychological factors [4]. This theory suggests that the brain can influence the perception of pain, either intensifying or diminishing it. Hence, effective pain management should extend beyond pharmacological treatments to include both the physiological and psychological aspects of pain [5]. While opioids remain a powerful option for managing pain at multiple levels, the ongoing global opioid crisis underscores the risks associated with these drugs. Worldwide, approximately 40 million individuals suffer from opioid dependence, with 12% of patients in Korea who have been prescribed opioid analgesics such as fentanyl showing signs of abuse [6]. The severe physical side effects of opioids, such as respiratory depression, are another concern for physicians, which further complicates their use. Therefore, while opioids should remain a key component of wound care pain management, there is a pressing need to explore adjunct treatments that address both psychological and physiological aspects of pain.
In response to these challenges, non-pharmacologic interventions like virtual reality (VR) have emerged as promising alternatives. VR is a technology that immerses users in a simulated environment, offering an interactive and lifelike experience. Recent studies have demonstrated the benefits of VR across various medical fields, including surgery and spinal interventions, as well as its utility as a training tool [7-9]. In pain medicine, VR has gained attention for its potential to manage pain effectively, providing a novel, noninvasive approach. Hoffman et al. [10,11] pioneered the use of VR as a distraction technique to reduce pain during burn wound care. When patients immerse themselves in VR, which requires substantial cognitive focus, it limits the brain’s capacity to process pain signals, resulting in reduced pain perception [10,11]. This promising reduction in pain intensity with VR opens the door for broader applications in wound care, offering a complementary option to pharmacologic interventions. Recent bibliometric analysis further supports the increasing trend in VR research for pain management, emphasizing its effectiveness in both acute and chronic pain scenarios, including burn care and neuropathic pain [12].
In this review, we will explore the current academic understanding of wound pain management, focusing on both pharmacologic and non-pharmacologic approaches. The pharmacologic section will discuss local and systemic strategies, including the use of new foam dressings designed to reduce local pain. The non-pharmacologic section will examine emerging interventions such as VR, which shows potential for pain reduction. By evaluating these diverse strategies, this review aims to provide insights into optimizing pain management and suggest future directions for advancing wound care practices.
Nociceptive and neuropathic pain
Pain is typically divided into two main categories: nociceptive pain and neuropathic pain [13]. Nociceptive pain is the body’s natural response to potentially harmful stimuli, acting as a warning system to alert us to possible injury or tissue damage [14]. It often arises from acute or chronic inflammation and is usually described with terms like throbbing, aching, or tenderness [15]. This kind of pain occurs when nociceptors—free nerve endings found in the skin, muscles, and internal organs—are activated by tissue damage or inflammation [16]. These nociceptors remain inactive until they encounter harmful stimuli, such as mechanical pressure, heat, or chemical irritants [17]. Once activated, they send electrical signals through primary afferent nerves, including A-delta fibers and C-fibers, to the spinal cord’s dorsal horn. Here, the signal is relayed to second-order neurons, which carry the message to the brain for processing and perception. This mechanism not only triggers a reflex to avoid further harm but also prompts the release of inflammatory substances like histamine and serotonin, which can heighten the sensitivity of nociceptors and intensify pain sensation [18].
Neuropathic pain, on the other hand, stems from dysfunction or damage within the nervous system itself. Unlike nociceptive pain, which responds to external harm, neuropathic pain originates within the nervous system and is often chronic and more challenging to manage [19]. Conditions like nerve injuries, diabetes, shingles, or multiple sclerosis can lead to this type of pain, which is often described as burning, tingling, shooting, or like an electric shock [20]. In neuropathic pain, damaged nerves may send faulty signals to the brain, even when there is no obvious external cause [21]. The nervous system may undergo changes, such as alterations in nerve signal transmission and increased sensitivity within the spinal cord and brain, a process known as central sensitization. This can result in conditions like allodynia, where a normally non-painful touch becomes painful, or hyperalgesia, an exaggerated response to a painful stimulus [22]. Neuropathic pain is complex, involving abnormal nerve activity, decreased inhibition in the spinal cord, and heightened excitability in pain pathways. Recognizing the source of a patient’s pain is crucial for effective treatment, as neuropathic pain often requires different strategies, such as the use of anticonvulsants, antidepressants, or nerve blocks, compared to nociceptive pain. While anti-inflammatory drugs and analgesics may work well for nociceptive pain, they are often less effective for neuropathic pain, which demands a more targeted approach [23].
Types of pain related to wounds
Background pain (basal or baseline pain)
Background pain, also known as baseline pain, is a persistent or intermittent discomfort experienced throughout the day, irrespective of movement. It is generally associated with the wound’s underlying pathological conditions, particularly local inflammation. In individuals with chronic wounds like leg ulcers, background pain can significantly impact daily activities and quality of life. For instance, a study focusing on patients with chronic leg ulcers found that background pain interfered mostly with general activities, sleep, and mobility. Patients often describe this pain as tender, stabbing, aching, or hot-burning. Unaddressed, this persistent pain can lead to physical and psychological distress, reducing the patient’s overall well-being. Proper management involves identifying and addressing the root cause of the wound while providing consistent analgesia. Despite its significance, background pain is often underassessed and undertreated in clinical practice, leading many patients to believe that such pain is an inevitable aspect of their condition [24].
Breakthrough pain (incident pain)
Breakthrough pain is a sudden, intense spike in pain that occurs despite otherwise controlled background pain [25]. This type of pain tends to arise when there is an already stable level of persistent pain control. It is often triggered by specific activities such as movement or wound care. This type of pain is typically brief but severe. In chronic wound patients, activities like moving or changing dressings can provoke breakthrough pain. Dressing removal, in particular, is often cited as one of the most painful procedures for patients [26]. Moreover, this pain can lead to fear and anxiety, worsening the overall pain experience. To manage breakthrough pain effectively, clinicians often use short-acting medications to provide rapid relief. Pre-emptive measures like administering analgesics before dressing changes and using gentle handling techniques are crucial in minimizing this pain.
Procedural pain
Procedural pain is pain that occurs during routine WCPs, such as dressing removal, wound cleansing, or debridement. Patients often describe procedural pain as one of the most distressing parts of wound care. Dressing changes, in particular, can be extremely painful, especially when adhesives stick to the wound or when the procedure causes trauma to the surrounding skin [27]. This pain can be so anticipated that patients experience anxiety before the procedure, intensifying the pain perception. The use of atraumatic dressings, premedication, and gentle techniques during procedures are key strategies in reducing procedural pain. Involving patients in care decisions is important to reduce anxiety and improve the overall experience.
Operative pain
Operative pain occurs following procedures that involve the use of local or general anesthesia, such as skin grafting or debridement. This pain is associated with tissue trauma from surgery and is usually more intense and short-term. Postoperative pain has been shown to delay wound healing and prolong recovery times if not managed effectively [28]. Effective perioperative pain management involves using appropriate anesthetics and providing adequate postoperative analgesia. This approach helps in promoting faster recovery and better wound healing outcomes.
Pain memories, anxiety, and stress
When pain is inadequately managed, it can lead to the nervous system becoming more sensitive. This increased sensitivity can cause even mild, non-painful stimuli to be perceived as painful, a condition known as allodynia. Over time, repeated exposure to pain experiences imprints these memories into the central nervous system, a phenomenon referred to as “pain memory” [29]. Essentially, a person’s past encounters with pain can shape their expectations of future pain, amplifying the overall perception of pain. For instance, repeated pain during dressing changes can significantly heighten the individual’s anticipation and sensitivity to pain during subsequent procedures. This creates a cycle in which the fear of pain increases the perception of pain, making patients more attuned to any discomfort they experience.
In addition to pain memories, the emotional responses of stress and anxiety play a crucial role in amplifying pain. The body’s reaction to pain activates the sympathetic nervous system, triggering a release of cortisol, a hormone central to the body’s stress response. Elevated levels of cortisol disrupt key processes necessary for wound healing, such as the functions of macrophages, which are critical for cleaning out debris from the wound site [30]. Additionally, cortisol inhibits fibroblast activity, slowing tissue repair, and accelerates the breakdown of the extracellular matrix [31]. The rise in cortisol also leads to increased production of catecholamines, which constrict blood vessels and reduce blood flow to peripheral tissues, further hindering wound healing. Thus, the chronic stress response not only exacerbates the perception of pain but also has a detrimental effect on the body’s healing process.
Contributing factors to high pain intensity in WCPs
Several patient-level and wound-level factors play a role in influencing pain intensity during WCPs, particularly during dressing changes [2]. Understanding these factors is essential for predicting which patients are likely to experience severe pain, allowing for more targeted and personalized pain management strategies.
Patient-level factors include younger age, as younger patients generally report higher pain intensity compared to older individuals, possibly due to differences in pain sensitivity and nervous system function [32]. Females tend to experience more pain than males, potentially due to hormonal differences and a greater sensitivity to noxious stimuli [33]. Non-White individuals, especially African-Americans and Latinos, often report higher pain intensities compared to Caucasians, influenced by both physiological and sociocultural factors [34]. Patients with chronic pain conditions, such as fibromyalgia, experience heightened pain sensitivity due to changes in central nervous system pain processing [35]. Additionally, opioid tolerance from long-term opioid use can result in opioid-induced hyperalgesia, leading to increased pain sensitivity [36]. Psychological factors like anxiety, depression, and pain catastrophizing further exacerbate pain during WCPs. Higher levels of anticipatory anxiety before procedures, as well as the emotional and cognitive magnification of pain, are strongly linked to more intense pain [37].
Wound-level factors include recent injury or tissue loss, as acute wounds are more painful due to the release of sensitizing inflammatory cytokines, especially in the early inflammatory phase. Chronic wounds are also associated with prolonged inflammation which can lead to higher pain levels [26]. Additionally, signs of clinical inflammation, such as redness or heat, reflect ongoing immune activity, contributing to increased pain. Resting wound pain indicates nociceptive sensitization, making any wound manipulation more painful [38]. Finally, superficial, partial-thickness wounds can cause more pain than deeper wounds due to the higher density of nociceptors in cutaneous tissues [2].
Clinical tool to predict severe pain during WCPs
Gardner et al. [39] conducted a study to create a clinical tool aimed at predicting severe pain during wound dressing changes by analyzing key patient and wound-related factors. Through a full logistic regression model, the study identified three critical predictors of severe pain during these procedures: type of dressing, resting pain intensity, and expected pain intensity. Of these factors, negative pressure wound therapy without a non-adherent layer was strongly associated with higher pain levels. Patients who reported elevated resting pain prior to the procedure were more prone to experiencing severe pain, and those with higher anticipated pain, or expected pain, also reported more intense pain during dressing changes. This tool demonstrated a high level of accuracy in distinguishing between mild to moderate pain (numerical rating scale, NRS 7 or below) and severe pain (NRS 8–10), with an area under the receiver operating characteristic curve of 0.826. This means that in 82.6% of cases, the tool could correctly identify which patient is more likely to experience severe pain. These findings allow clinicians to take a more targeted approach, implementing strategies like preemptive analgesia, specialized dressings, and other tailored interventions in a way that is both cost-effective and personalized.
Wound pain management model
The Wound Pain Management Model (WPMM) was developed to help healthcare professionals manage chronic wound pain comprehensively, from pain assessment and identifying underlying causes to providing both local and systemic treatments [40]. There are four steps in treating wound pain, as outlined in Table 1: wound assessment, local wound management, wound pain assessment, and wound pain management [40]. The first step involves evaluating the wound itself, analyzing its cause, and addressing it. For example, diabetic foot ulcers require both proper diabetes management and preventive foot care. In cases like venous or ischemic ulcers, efforts focus on correcting the underlying vascular issues. The second step is local wound management, which involves cleansing and debridement. If inflammation persists, topical treatments may be necessary, and antibiotics should be considered if an infection is suspected. The third step is wound pain assessment, which includes evaluating the pain’s location, duration, intensity, type, and impact on sleep. The final step is wound pain management. It is crucial to determine whether the patient’s pain is continuous or temporary and decide when to apply pain management. Local treatments should be considered first, including the application of local analgesics or cleansing with saline without medication. If the pain persists, oral medication should be considered, with the choice of medication depending on the type of pain.
Wound Pain Management Model
Wound pain assessment
Assessing wound-related pain requires a comprehensive evaluation of multiple factors, including the pain’s location, duration, intensity, quality, changes, and its impact on daily living, to guide effective treatment [41]. Proper assessment and documentation are crucial because unaddressed pain can lead to complications and poor wound healing. Localization is the first step in approaching wound pain, helping clinicians identify whether the discomfort stems from the wound bed, the surrounding area, or another region. This localization directs appropriate interventions and treatments. For example, pain originating in the wound bed might indicate direct tissue damage, while pain around the wound may suggest infection or other complications.
The duration of the pain provides further insight. Distinguishing between persistent pain, which is present at rest or during activities, and temporary pain, which may occur during dressing changes, cleansing, or debridement, is important. Changes in pain duration or nature necessitate reassessment, as persistent pain might indicate ongoing pathological processes, whereas temporary pain often relates to procedural or activity-induced factors.
Intensity is another key dimension of pain assessment. Since pain is subjective, using standardized scales such as the visual analog scale (VAS), numeric box scale, or faces scale helps quantify pain levels and monitor changes over time [42]. For patients with literacy or cognitive issues, simpler methods like asking, “Is the pain better, worse, or the same?” can be effective. Regular measurement ensures that the patient’s pain experience is recognized and managed appropriately, aiding in tailoring treatment plans to their needs.
Understanding the quality of the pain also plays a vital role. Patients should describe their pain using terms like aching, throbbing, burning, or stabbing, which can help differentiate between nociceptive and neuropathic pain. Proper identification of the pain type is crucial for guiding treatment, as many patients experience both types, requiring a multifaceted approach.
New or increased pain should prompt immediate reassessment, as it can signal changes in the wound, such as increased inflammation or infection. Quick evaluation and intervention are crucial to prevent further complications. Additionally, assessing how pain impacts the patient’s activities of daily living, including sleep, mobility, appetite, and mood, is essential for understanding its broader effects on quality of life. Effective pain management should aim to minimize these disruptions, supporting the patient’s overall well-being and daily functioning.
The WPMM provides a framework for comprehensive pain assessment, emphasizing the need to ask patients about their pain in detail. This includes exploring how their pain affects their daily activities and using validated pain measurement scales regularly to monitor its impact on factors such as sleep, mood, and anxiety. Documentation of the patient’s pain experience, whether through patient diaries or healthcare records, is crucial for guiding treatment. The more frequently healthcare professionals assess and document pain, the better the chances of implementing or modifying pain management strategies effectively.
Wound pain management
Local wound pain treatment: dressing strategies
Adherent or dry dressings can increase pain by sending heightened sensory signals to nociceptors [43]. In contrast, moisture-retaining dressings that are easy to remove, such as polyacrylate dressings, cause significantly less irritation and facilitate painless debridement by removing biofilms [44]. Similarly, hydrogels, hydrofibers, alginates, soft silicones, and cellulose dressings minimize pain during removal while promoting healing [45].
Selecting the appropriate absorbent dressing helps reduce the frequency of changes, preventing unnecessary disturbance to the wound bed and avoiding further pain. Contact layer dressings that remain close to the wound bed have been shown to lower pain levels during changes by minimizing tissue disruption [46]. Additionally, silver-based dressings, such as ionic silver hydrogels, provide antimicrobial protection and allow for painless debridement, further reducing discomfort [47]. These dressings also mitigate unpleasant odors from infections, decreasing another noxious aspect of wounds for enhanced comfort.
Adhesive dressings can cause discomfort, especially in sensitive areas. Low-sensitivity adhesives and “tapeless” alternatives, such as Montgomery straps and elastic netting, reduce pain during application and removal [48]. Protecting the periwound skin with polymer skin barriers reduces trauma during dressing changes [49]. Moistening dried dressings with isotonic solutions before removal can also minimize pain and tissue damage [50].
Foam dressings that release ibuprofen in response to wound exudate can provide both pain relief and effective exudate management. Research suggests that topical nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, do not interfere with wound healing and have fewer side effects than oral treatments, making them a promising option for managing chronic wound pain [51].
Systemic wound pain treatment
Systemic wound pain treatment involves managing both nociceptive and neuropathic pain, often requiring pharmacological interventions tailored to the type and severity of pain experienced by the patient. The selection of medications is guided by the nature and severity of the pain experienced by the patient. For neuropathic pain, first-line treatments typically include gabapentinoids (such as pregabalin and gabapentin), tricyclic antidepressants (TCAs) (such as amitriptyline), and noradrenaline/serotonin uptake inhibitors (such as duloxetine) [52]. These medications target various pain pathways and neurotransmitters to alleviate the abnormal pain signals originating from nerve damage. Gabapentinoids act on the α2δ-1 subunit of voltage-gated calcium channels, reducing calcium influx and decreasing excitatory neurotransmitter release. However, gabapentinoids may cause dizziness, sedation, and, in some cases, dependence with prolonged use [53]. TCAs and serotonin reuptake inhibitors influence the noradrenaline and serotonin systems, both critical in pain modulation, but they are often associated with side effects like dry mouth, drowsiness, and potential cardiovascular issues, limiting their use in certain populations [54].
In cases where nociceptive pain is predominant, systemic treatments typically follow the World Health Organization analgesic ladder, starting with non-opioid options like NSAIDs (such as ibuprofen or paracetamol) for mild to moderate pain and progressing to opioids (such as tramadol or morphine) for more severe pain [55]. NSAIDs help reduce pain by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which are involved in inflammatory pathways. While effective, prolonged use of NSAIDs can lead to gastrointestinal issues, renal impairment, and elevated cardiovascular risks [56]. Opioids are reserved for severe pain due to their powerful analgesic effects. They work by binding to opioid receptors (mu, kappa, and delta) located in the brain, spinal cord, and peripheral nervous system. The mu-opioid receptor is primarily responsible for pain relief, as it diminishes perception of pain. However, opioids carry significant risks, particularly tolerance and dependence, which complicate their long-term use. Tolerance develops when the body becomes less responsive to the drug over time, requiring higher doses for the same effect, which increases the risk of side effects and overdose. Dependence occurs as the body adapts to the drug, leading to withdrawal symptoms if the opioid is reduced or stopped. In more severe cases, long-term use may lead to addiction, characterized by psychological craving and misuse, contributing to the global opioid crisis. Due to these risks, opioids should be used cautiously, especially for chronic pain, with regular monitoring by healthcare professionals [57,58].
Psychosocial wound pain management
In cases where patients are hesitant to use or refuse pharmacological interventions, psychological therapies can play a crucial role in pain relief. Community intervention programs, for example, have been shown to help reduce pain and improve wound healing outcomes through social support and mental health interventions [59]. These programs highlight the importance of a holistic approach that includes not only physical treatment but also emotional well-being in pain management. Interestingly, some medications traditionally used for neuropathic pain, such as TCAs and duloxetine, were initially developed as antidepressants. These drugs, in addition to relieving pain, may offer emotional support by addressing the psychological aspects of chronic pain [60]. Their dual function can be particularly beneficial in patients who experience both physical pain and emotional distress, underscoring the complex interaction between pain perception and mental health. Interventional pain management techniques, such as sympathetic nerve blocks, are another option that addresses both physical and psychological aspects of pain. By reducing norepinephrine levels, sympathetic blocks help alleviate the stress-related responses that often exacerbate pain, providing a more comprehensive pain management strategy [61].
Current status of research on VR in reducing pain during WCPs
Source of data, search strategy, and data collection
We conducted a search in the Web of Science (WoS) Core Collection database to investigate the utility of VR in reducing pain during WCPs, focusing on original articles published until 2023 and indexed in the Science Citation Index Expanded (SCIE) and Emerging Sources Citation Index (ESCI). The WoS Core Collection database is widely used in pain medicine-related research. Our search strategy included title searches for terms related to VR (“virtual reality” or “augmented reality” or “mixed reality” or “computer-mediated reality”), terms related to WCPs (“wound care” or “wound dressing” or “wound cleansing” or “dressing change” or “burn care”) and the term of “pain.” Titles and abstracts were screened, and relevant articles were selected for further review. We specifically focused on articles written in English. Articles lacking full-text availability were excluded from the analysis.
Previous studies using VR during WCPs
The studies involving VR during WCPs are summarized in Table 2 [62-70]. In some cases, a VR headset was used solely for watching distraction videos, while in others, both a VR headset and a controller were used, allowing patients to interact with games or virtual scenarios. The research included different study designs, such as prospective studies (n=2) and randomized controlled trials (RCTs; n=7). Two of the studies specifically targeted adolescents under the age of 18, while the remaining studies included both adolescents and adults in their participant groups. Six of these studies focused on burn pain, while the remaining studies examined conditions like diabetic and venous ulcers, post-surgical wounds from perineal abscess, and hand injuries.
Previous studies using VR during wound care procedures
A prospective study by Faber et al. [64] on severe burn patients using VR during WCPs found significant reductions in pain intensity. Compared to the baseline day (day 0) without VR, pain scores on days 1, 2, and 3 with VR were significantly lower. Although the difference in pain scores was not statistically significant beyond day 3, the trend of reduced pain persisted up to day 6. These findings suggest VR is effective in reducing pain for at least 3 days during WCPs. Another prospective study conducted by van Twiller et al. [69] on severe burn patients showed that both VR and television significantly reduced pain scores during wound dressing changes. Notably, this was the first study to compare VR with other distraction methods, demonstrating that while TV reduced pain by 29%, VR resulted in an even greater reduction, with 16 out of 19 patients experiencing an average pain reduction of 56%. However, while VR showed greater effectiveness, the difference between the two was not statistically significant.
An RCT performed by de Araujo et al. [63] comparing VR to standard care during chronic wound dressing changes (e.g., diabetic and venous ulcers) found that participants who used VR experienced significantly less pain during and after dressing changes. Similarly, an RCT by Zheng and Liu on postoperative dressing changes in patients with perineal abscesses reported that those in the VR group had significantly lower pain levels than the control group, with a more consistent reduction in pain over time [70]. The RCT involving patients with hand injuries conducted by Guo et al. [65] showed a significant reduction in pain intensity with VR during wound care compared to the control group.
However, not all studies found statistically significant results. The study of Blokzijl et al. [62] on VR as a pain relief for burn care indicated that, although there was a trend of lower pain intensity and reduced pain medication usage in the VR group, this did not reach statistical significance when compared to the usual care group. Kipping et al. [68] demonstrated in their RCT involving adolescents that, while VR did not significantly lower pain levels compared to standard distraction methods (like TV, stories, or music), it did result in a decrease in the need for rescue doses of Entonox, with the only significant difference observed during nursing staff ’s pain assessments during dressing removal. Lastly, Jeffs et al. [67] conducted an RCT focusing on adolescent burn wound care and found no significant difference in pain levels between VR and standard care, suggesting that while VR may serve as an adjunctive tool, it might not fully replace the unique nurse-patient interaction crucial during clinical care.
Expected future studies
Future research on wound pain management should focus on key areas to enhance the use of VR and artificial intelligence (AI). Larger RCTs are needed to confirm VR’s effectiveness across different wound types and procedures, such as dressing changes and debridement. Comparative studies between immersive and non-immersive VR experiences should be prioritized, and the long-term benefits of repeated VR use in wound care should also be investigated. Separate studies focusing on pediatric and adult populations will offer insights into how age and cognitive factors affect VR’s efficacy. Furthermore, understanding individual patient factors like anxiety and psychological readiness is essential to optimizing VR interventions, and research should explore how VR can work alongside pharmacological treatments to reduce opioid reliance.
AI has the potential to further improve wound pain management by creating predictive models that analyze patient-specific factors to anticipate pain levels during procedures, allowing healthcare providers to make proactive treatment adjustments. AI-enhanced VR systems could also respond to real-time patient feedback, adjusting the virtual environment to enhance pain relief [71]. Additionally, AI-driven wound monitoring could analyze high-resolution images and predict increases in wound pain, providing healthcare teams with timely alerts to intervene earlier [72,73]. Future studies should also assess the cost-effectiveness of implementing these technologies to ensure they are both accessible and sustainable in clinical practice.
Limitations
Our investigation on the WoS Core Collection database has several limitations that should be noted. First, despite a comprehensive search strategy, it is possible that some relevant studies on VR in wound pain management were not captured, especially those not indexed in the databases we searched or published in languages other than English. Additionally, studies on VR in wound care often differ in design, with variations in the types of VR technology used (immersive vs. non-immersive), the wound types examined (burns, chronic ulcers, surgical wounds), and the patient populations involved (children vs. adults). These differences make it challenging to compare outcomes directly across studies and to draw consistent conclusions about VR’s effectiveness. Many of the studies we reviewed had small sample sizes and focused mainly on short-term outcomes, making it harder to generalize the findings to broader populations or assess long-term effects. Furthermore, the lack of standardization in measuring pain relief and the differences in VR technology add another layer of complexity when trying to compare results.
Conclusion
Wound pain management is a critical aspect of patient care, particularly given the complex nature of pain associated with both acute and chronic wounds. While pharmacologic treatments, including opioids, remain a cornerstone of managing wound pain, the risks associated with long-term opioid use highlight the need for alternative and adjunctive therapies. Non-pharmacologic interventions, such as VR, offer promising results, providing a noninvasive method to reduce pain intensity during WCPs. VR’s ability to divert cognitive focus away from pain shows potential for widespread application, especially for procedures like dressing changes and debridement that are often associated with high pain intensity. However, current research indicates variability in the effectiveness of VR, with some studies showing significant reductions in pain and others reporting mixed results. To establish VR as a viable therapeutic option for wound pain management, future research should focus on well-designed studies with sufficient sample sizes, particularly those that compare immersive and non-immersive VR interventions in pediatric and adult populations.
Notes
No potential conflict of interest relevant to this article was reported.