[Pain and basic functional activites in a group of patients with cutaneous wounds under V.A.C therapy in hospital setting].
BACKGROUND
Topical Negative Pressure Wound Therapy (NPWT), in Italy known as V.A.C. (Vacuum Assisted Closure) system, is used for the management of chronic wounds not responding to conventional therapies. To date, no data concerning the impact of this device on pain, functional activities and pain-killers' administration , is available.


METHODS
over a 3-year period, 32 patients with cutaneous wounds undergoing V.A.C. therapy were admitted. Data related to 25 patients with an average age of 62.7 years was collected. Pain, patient autonomy and consumption of analgesic drugs were evaluated before and during V.A.C. therapy.


RESULTS
The average pain score without V.A.C. was 4.2 +/- 2.4) during the first day of therapy the average pain score was 6.2 +/- 2.8). Before and after V.A.C. therapy, a similar number of patients (17/25 vs 19/25) used pain-killers, but the dosage had to be noticeably increased; 5 patients out of 25 asked for the interruption of V.A.C. therapy due to pain. The therapeutic response to the pain-killers was poor. Among 25 patients, the number of the basic functions lost before V.A.C. therapy was 20 , but under V.A.C. therapy another 49 functions were lost, bringing the total to 69.


CONCLUSIONS
Cutaneous wounds often represent a painful experience for the patients. Despite the strong increase in the consumption of pain-killers, there was an increased level of pain and a higher degree of dependence during the V.A.C. therapy. Healthcare professionals tended to underestimate the impact of the device in the genesis of the pain reported by patients.


CONCLUSIONS
When selecting the type of treatment, the pain of the patient should be considered as a primary outcome. Increased levels of pain associated with the loss of autonomy during V.A.C. therapy increase nurses' workload and worsen patients' quality of life. However, these factors are not considered in the cost-benefit analyses.
Apostoli
Alberto
A
Azienda Spedali Civili, Brescia.
Caula
Claudia
C
D000203:Activities of Daily Living; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects*; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D012867:Skin / Q000293:injuries*