Interventions to reduce pain at dressing change of chronic wounds: a mixed-methods systematic review.

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.