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Monitor all patients for pain at pressure areas, say researchers


One in eight acute patients experience pain, soreness or discomfort on skin sites deemed “at risk” of ulcers, even when there is no obvious tissue damage, according to UK researchers.

The Leeds University study looked at unattributed pressure area-related pain prevalence in nine hospitals, with 2,010 patients completing a survey.

The researchers said 1,769 patients had no pressure ulcers but 12.6%, or one in eight, reported unattributed pressure area-related pain.

Of the 241 patients with pressure ulcers, 104 patients reported pain – a prevalence of 43.2% or more than two out of five.

The authors said their findings “provide a clear indication” that all patients should be asked if they have pain at pressure areas even when they do not have press ulcers. 

“This is in an area which is a priority for patients and impacts upon the quality of life of nearly half of the population,” they said in the online journal BMC Nursing.

They noted that patients with pressure ulcers reported that pain was their most distressing symptom, but there had been few previous studies into pressure ulcer pain prevalence.

They said: “This study is the first to assess unattributed pressure area-related pain in a large representative hospital population including patients with and without pressure ulcers.”

The organisations involved in the study were two large UK teaching hospital trusts, running a total of six hospitals, and one district general hospital trust, running three hospitals.

A total of 3,397 patients were included in routine pressure ulcer prevalence audits at the hospitals, of which 59% participated in the pain prevalence study.

The authors added: “The importance of inclusion of patients without pressure ulcers is underlined by the findings that 12.6% of patients without pressure ulcers reported pain on an ‘at risk’ skin site.”

“This group could be important because they are reporting pain over an ‘at risk’ skin site which they believed to be caused by pressure but they were not yet displaying damage clinically,” they said.

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Readers' comments (7)

  • Do you have any pain ?


    Where is your pain ?

    "I dont know"


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  • Florence

    Researchers? Oh please this is basic training! Pathetic!

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  • There are established recognised tools for identifying pain even in those who cannot self report, there is no excuse today for patients being in pain, the poverty in our care system is in staff not being trained in how to use pain assessment tools and in not using them

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  • you don't always feel pain on pressure areas before a sore develops. I have one to prove it on my elbow from persistant mouse manipulation and leaning my elbow on the table.

    I only recently discovered it when I bought new body lotion and lifted my elbow in front of the mirror to apply it.

    the only remedy apart from ceasing use it is to put a small cushion under it as I don't think massage and cream alone will cure it. I still don't feel it and have the impression that unless pressure sores are deep or infected they may not always be felt by which time it is too late. our patients let us treat some nasty sores but rarely expressed much feeling of pain.


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  • How about re-positioning every two hours?

    How about investing in alternating air pressure mattresses that disperses pressure especially in those patients who are unable to move themselves.

    Is that no longer an option or has this practice been proven not to work?

    I think it is more economical and kinder to invest in prevention.

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  • Studies have suggested pain receptors in muscle & skin below the lesion in spinal cord injured individuals do not trigger autonomic dysreflexia.

    I contribute to the care of an individual that suffers this potentially life threatening condition.

    It has taken well over a year to convince district nurses that an area on the heel of a foot contributes to unnecessary AD reactions despite no apparent obvious tissue damage in this area.

    Often weeks passed before this ‘at risk’ area developed signs of pressure-related damage (skin breaks down, becomes red, inflamed) thus weeks of compromised health passed before any intervention was delivered; the individual suffered, was at risk of episodic high blood pressure.

    It is important to recognise groups that do not display damage clinically.

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  • water mattresses were our most effective tool but obviously only of limited availability.

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