The management of procedural pain in the fungating malignant wounds of the cervical and facial area

Fungating malignant wounds (FMW) are chronic wounds defined as a skin infiltration by the tumor or metastases. They may be present as raised nodules similar to a cauliflower (proliferative), as a crateriform ulcer (destructive) or a combination of both. The FMW are often associated with different signs, most commonly odor, exudate, bleeding, related wound pain, slough/necrosis, infection and pruritus. In addition the wounds of the cervico-facial district expose the patient to psychological and social problems. Therefore patients with FMW require palliative care and proper management of the wound, not only for the control of wound-related physical symptoms, but also for the resolution of psychosocial problems. From January 1, 2016 to May 31, 2017, a total of 18 patients were observed, including 12 men and 6 women with FMW. Pain was assessed with a validated Numerical Rating Scale, with a range from 0 to 10, where 0 corresponds to the absence of pain and 10 to the maximum of imaginable pain. To evaluate the amount of pain perceived by patients during dressing changes, including the steps of Removal, Cleansing, Debridment, Perilesional skin care, Dressing application, closure and fixation. Removal: average pain 2,3 DS±1. Cleansing: average pain 3,4 DS±2. Debridment: average pain 3,4 DS±2. Dressing Application and Fixation: average pain 5,3 DS±1. In the light of the results, there is a need for better dressing related pain control. For this purpose a multidisciplinary group was formed. The working group developed appropriate therapeutic patterns differentiated in relation to the pain before the intervention and the presence or absence of supportive therapy for the underlying oncological disease. These therapeutic schemes will be tested in practice in order to evaluate their effectiveness on the management of procedural pain.