title: Pain related to maggot debridement therapy.
abstract: OBJECTIVE
  To summarise our experience with maggot debridement therapy (MDT) in relation to pain observed in patients treated in 16 departments and units of the Hadassah Hospital in Jerusalem, Israel.
  
  
  METHODS
  A secondary analysis of data from 435 patients. Maggots were either placed directly on the wound using a cage-like dressing (DA), or they were applied to the wound encased in a previously prepared hermetic tea-bag like pouch (TBA). During each treatment, patients were asked whether they felt any difference in the level of pain before and during MDT treatment.
  
  
  RESULTS
  Overall, 165 patients (38%) reported increased pain during MDT. Seventeen patients (41%), who were treated with the TBA technique, and 148 patients (38%), who were treated with the DA technique, reported increased pain and were treated with analgesics before or during MDT. In five patients, the treatment had to be discontinued due to uncontrolled pain during MDT. Pain control measures were undertaken in patients who were already in intense pain prior to the initiation of MDT and in those patients who reported intense pain during DA treatment. The measures included shorter periods of application of maggots, use of the TBA rather than DA technique, and applying relatively small maggots as well as a smaller number of maggots during an MDT session. In patients who continued reporting intense pain, systemic analgesic medications and peripheral nerve blocks were used.
  
  
  CONCLUSIONS
  Since a full debridement requires an average of 2-3 maggot cycles, which last 3-5 days, and since a large percentage of patients treated with MDT complain of pain that may last throughout the therapy period, it is deemed worthwhile and even essential to titrate analgesics as needed and be prepared to treat patients even with potent analgesics, such as opioids. In cases when pain is intense and uncontrolled with systemic medications, peripheral nerve blocks should be considered.
  
  
  BACKGROUND
  There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
authors.affiliation: Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectiuos and Tropical Diseases, Hadassah Medical School, The Hebrew University, Jerusalem, Isreal.
authors.forename: K Y
authors.initials: KY
authors.lastname: Mumcuoglu
authors.forename: E
authors.initials: E
authors.lastname: Davidson
authors.forename: A
authors.initials: A
authors.lastname: Avidan
authors.forename: L
authors.initials: L
authors.lastname: Gilead
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000818:Animals; D003646:Debridement / Q000009:adverse effects* / Q000379:methods*; D004175:Diptera; D005260:Female; D006801:Humans; D007557:Israel; D007814:Larva; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*
chemical_list: D000700:Analgesics