Description of the goods or services required
19/72 Pain relief strategies for dressing change in chronic wounds
The aim of the HTA Programme is to ensure that high quality research information on the effectiveness, costs and broader impact of health technology is produced in the most efficient way for those who use, manage, provide care in or develop policy for the NHS. Topics for research are identified and prioritised to meet the needs of the NHS. Health technology assessment forms a substantial portfolio of work within the National Institute for Health Research and each year about fifty new studies are commissioned to help answer questions of direct importance to the NHS. The studies include both primary research and evidence synthesis.
Research Question: For people living in the community with chronic wounds and experiencing pain at dressing change:
i) What is the current evidence for strategies to relieve pain at dressing change?
ii) What are the pain relief strategies currently used in UK practice and what are patients’, carers’ and healthcare professionals’ use and experience of these?
iii) What are the requirements for an appropriate pain relief strategy, or strategies, which could be manualised, delivered and evaluated in the community?
1.Intervention: Pain-relief strategy, or strategies, to prevent and/or alleviate acute pain at dressing change for chronic wounds.
2.Patient group: Adults with dressing change pain related to chronic wounds, to be defined by applicants. The HTA programme recognises the heterogeneity of this patient group.
3.Setting: Any appropriate setting but must be generalizable to the community setting.
4.Study design: An evidence synthesis of the quantitative evidence on pain prevention and alleviation and qualitative evidence of experiences of patients, carers and healthcare professionals. The review should be broad in nature and cover a wide range of patient groups, chronic wounds and interventions. The review is expected to identify generic effects that work across different patient groups, types of chronic wounds, as well as disorder/patient-specific effects.
A survey of current practice in the UK to document what is being used or not being used for a variety of wounds.
Results of the evidence synthesis and survey to be brought together in order to suggest possible future primary research using manualised intervention(s).
5.Important outputs: A review of the current evidence for pain relief strategies at dressing change; an overview of current practice; stakeholder experiences; requirements for a manualised intervention(s) deliverable within the community; key design elements of a future study.
Chronic wounds represent a substantial burden to patients, carers and the NHS. There exists a wide variety of chronic wounds and a wide variety of people affected by them. The most common chronic wounds are venous leg ulcers, pressure ulcers and diabetic foot ulcers. Each type of wound has a different aetiology, symptoms and treatment regimens. However, common across all these different types of chronic wound is the need for regular dressing changes (at least several times per week), which is often a very painful experience and can lead to great distress for the patient.
Most guidelines and treatment regimens are tailored to wound healing and only attend to pain as a secondary consideration. As a result, there is no clear guidance on how patients, carers and healthcare professionals should manage wound-related pain at dressing change. Various strategies are employed in practice, often with little evidence to support their efficacy. Therefore, the HTA programme wishes to commission an evidence synthesis to determine what evidence exists for pain relief strategies, as well as a survey of current UK practice to determine what strategies are being used and which (if any) of these strategies appear to be effective and could be developed and evaluated in possible future primary research.
Applicants should note that the Programme Oversight Committee has estimated that the cost of this work should be around £250,000.