title: Determining pain levels in patients treated with maggot debridement therapy.
abstract: OBJECTIVE
  Pain as a complication of maggot debridement therapy (MDT) has been a topic of some controversy. This study set out to determine pain levels in patients treated with MDT.
  
  
  METHODS
  A retrospective analysis using a visual analogue scale (VAS) was performed: 41 patients were treated with MDT for non-healing wounds (22 men and 19 women; average age: 67 years). Average wound duration was 14 months (range: two weeks to 132 months). Maggots were applied using the contained or the free-range techniques. Paracetamol (1 g three times daily) and Durogesic plaster (25 microg every three days and 50 microg the day before the maggot change) were given for pain relief in the outpatient clinic.
  
  
  RESULTS
  Diabetic patients experienced the same amount of pain before and during MDT. Eight out of 20 non-diabetic patients experienced more pain during MDT than before; the remaining non-diabetic patients had the same amount of pain before and during the therapy. The difference between diabetic and non-diabetic patients was statistically significant (p<0.05) for all applications combined.
  
  
  CONCLUSIONS
  In 78% of patients (29/37) pain can be adequately treated with analgesic therapy. However, if pain is unmanageable in the outpatient department, we believe that options include hospital admission, using the contained method of application or, in the worst case scenario, cessation of treatment. A standardised but individually tailored pain management protocol is mandatory.
authors.affiliation: Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands. p.steenvoorde@lumc.nl
authors.forename: P
authors.initials: P
authors.lastname: Steenvoorde
authors.forename: T
authors.initials: T
authors.lastname: Budding
authors.forename: J
authors.initials: J
authors.lastname: Oskam
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000818:Animals; D001458:Bandages; D003646:Debridement / Q000009:adverse effects* / Q000379:methods*; D017719:Diabetic Foot / Q000628:therapy*; D004175:Diptera; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007814:Larva; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control; D010147:Pain Measurement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014945:Wound Healing; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D005283:Fentanyl