Authors' objectives: Pain during dressing changes is a major concern for individuals with chronic wounds, such as venous leg ulcers, diabetic foot ulcers and pressure sores. These procedures, often performed in community settings, can cause significant physical and emotional distress. Despite widespread recognition of this issue, there has been no comprehensive synthesis of evidence to guide effective pain management strategies during dressing changes. This mixed-methods systematic review aimed to evaluate interventions designed to reduce pain during dressing changes for chronic wounds and to explore the experiences of patients and healthcare professionals.

Authors' results and conclusions: Pain was found to be highly variable and influenced by wound type, healing stage and previous experiences. Non-adhesive and ibuprofen-releasing foam dressings consistently reduced pain, while gauze dressings were frequently associated with increased discomfort. Topical treatments, such as eutectic mixture of local anaesthetics cream and morphine gel, showed promise. Patients valued skilled, communicative nursing care and involvement in their own treatment. Distraction techniques and post-dressing pain relief were identified as important but under-researched. Pain assessment practices were inconsistent, and formal tools were rarely used. Effective pain management during dressing changes requires a holistic, patient-centred approach. While some interventions show promise, many commonly used strategies lack robust evidence. The preventing pain at dressing change pathway offers a practical framework for guiding future practice, research and policy development.

Authors' methods: Twenty-nine studies were included: 8 effectiveness studies, 11 surveys and 10 qualitative studies. Data were sourced from six electronic databases and analysed using a convergent segregated approach. Quantitative data were summarised using synthesis without meta-analysis guidance, while qualitative and survey data were analysed thematically. Findings were integrated using the preventing pain at dressing change pathway, a framework developed with stakeholder input to map interventions across the dressing change process. The broad scope of eligible interventions increases the risk of missing relevant studies. Most studies were small and at moderate to high risk of bias.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR131023

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/GJRC0808

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJRC0808

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk