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To explore whether different dressing types were associated with the pain and stress experiences of patients with chronic wounds.


  • This exploratory study was conducted to identify any differences between reported levels of pain and stress associated with the use of atraumatic and conventional dressings used in the treatment of patients with chronic wounds.
  • The following psychological measures were implemented:
    • The Perceived Stress Scale (PSS)
    • The State Trait Anxiety Inventory (STAI)
    • A numerical stress rating scale
  • At dressing change, the PSS and STAI questionnaires were read aloud to each patient and verbal responses were recorded by a member of the research team.


  • Of 49 patients with chronic wounds, 53% were male (n=26) and 47% were female (n=23). Age ranged between 38 and 95 years, with a mean age of 69.1±14.1.
  • Wound types were of varying aetiologies and were treated with either atraumatic dressings, such as Mepilex, or conventional dressings such as Biatain®* or Aquacel®* Ag, (Table 1).

*Aquacel is a registered trademark of ConvaTec Inc. Biatain is a registered trademark of Coloplast A/S.

Table 1. Wound aetiology

Wound type Atraumatic n(%)  Conventional n(%)
Venous leg ulcer 3 (30%) 5 (13%)
Other leg ulcer 2 (20%) 5 (13%)
Diabetic foot ulcer 1 (10%) 15 (38%)
Other foot ulcer 4 (40%) 8 (21%)
Other chronic wound - 6 (15%)
Total 10 39

Table 2. Mean psychological and physiological pain and stress scores for patients receiving atraumatic and conventional dressings

Pain/stress measures Atraumatic  Conventional
STAI 38.40 ± 15.62 33.1 ± 11.16
PSS 24.60 ± 10.08 22.72 ± 9.17
Numerical pain 1.43 ± 0.98* 3.66 ± 3.13*
Numerical stress 2.00 ± 0.58* 3.63 ± 2.66*
Heart rate 69.11 ± 7.53 75.62 ± 14.05
Respiration rate 16.86 ± 8.17 16.09 ± 1.95
Systolic blood pressure (BP) 125.70 ±  12.23 137.82 ± 17.03
Diastolic blood pressure (BP) 64.22 ± 11.56 69.13 ± 12.91
Galvanic skin response (GSR) 19.76 ± 5.42* 33.15 ± 16.32
Salivary sortisol 0.13 ± 0.03 0.17 ± 0.09

*Difference between groups statistically significant at p less than 0.05

STAI = state trait anxiety inventory; PSS = perceived stress scale

bar chart - comparison of Mepilex with other dressings Fig 1. Self-reported numerical stress and pain ratings of patients receiving atraumatic and conventional dressings as part of wound treatment.
  • In addition to the increased physiological indicators of stress among patients receiving conventional dressings, the self-reported severity of acute pain and stress also demonstrated higher pain and stress at dressing change for the conventional dressing group (Figure 1).

  • Stress scores on the PSS and STAI were relatively similar for patients receiving both types of dressings. Mean PSS scores were 24.60±10.08 for patients receiving atraumatic dressings and 22.72±9.17 for patients with conventional dressings, out of a maximum PSS score of 56.

  • Patients with atraumatic dressings scored an average of 34.90±11.41 for underlying anxiety and 38.40±15.62 for acute anxiety at dressing change, in comparison with the conventional dressing group, who scored an average of 33.21±11.20 for trait anxiety and 33.31±11.16 for acute anxiety at dressing change on the STAI, out of a maximum score of 80.

  • Patients’ average levels of underlying stress were 24.60 ± 10.08 (atraumatic dressings group) and 22.72 ± 9.17 (conventional dressings group) on the PSS and 34.90 (atraumatic dressings group) and 33.21 (conventional dressings group) on the STAI.

  • This could be taken to suggest that, although acute episodes of pain and stress were much lower in patients receiving atraumatic dressings, factors associated with the overall experience of living with a chronic wound may be contributing to underlying and ongoing feelings of stress and anxiety.

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