Co-occurring chronic pain and primary psychological disorders in adolescents: A scoping review.

Long-term health conditions, whether mental or physical, often co-occur in adolescents. For instance, adolescents with chronic pain may experience co-occurring primary psychological disorders. In this scoping review, we determine the influence of co-occurring chronic pain and primary psychological disorders on adolescents' functioning. A systematic search of six databases was conducted to identify articles if they were: (1) peer-reviewed; (2) reported original findings; (3) included participants aged 11-19 years, who experienced chronic pain (i.e., pain lasting 3 months or more) and had a co-occurring diagnosis of a primary psychological disorder; and (4) assessed functioning. Searches returned 9864 articles after the removal of duplicates. A two-phase abstract and full-text screening process identified two eligible articles which compared emotional functioning (n = 1) and social functioning (n = 2) between groups of adolescents with co-occurring chronic pain and primary psychological disorders with adolescents only reporting chronic pain. Overall findings revealed no differences in social functioning, but adolescents with co-occurring chronic pain and a primary psychological disorder (depression and anxiety) reported worse emotional functioning compared with adolescents with chronic pain alone. This review confirms the limited research on the co-occurrence of primary psychological disorders and chronic pain in adolescents by only identifying two eligible articles exploring the co-occurrence of chronic pain with depression, anxiety, and/or attentional disorders.

'A whirlwind of everything': The lived experience of adolescents with co-occurring chronic pain and mental health symptoms.

BACKGROUND: Co-occurring chronic pain and mental health issues are prevalent in adolescents, costly to society and can lead to increased risk of complications throughout the lifespan. While research has largely examined paediatric chronic pain and mental health in isolation, little is known about the unique challenges faced by adolescents who experience these co-occurring symptoms. This idiographic study examined the lived experience of adolescents with co-occurring chronic pain and mental health symptoms to identify salient issues for this population. METHODS: Semi-structured telephone interviews were conducted with seven adolescents (11-19 years) self-reporting diagnoses of both pain and mental health issues for a duration of 3 months or longer. Participants were recruited from UK-based schools, pain clinics and charities. Interview transcripts were analysed using interpretative phenomenological analysis. RESULTS: Analyses generated two themes 'a whirlwind of everything' and 'putting up fronts', which describe how the experience of co-occurring chronic pain and mental health symptoms typically disrupted adolescents' ability to regulate their physical, psychological and social wellbeing and identity. Adolescents described their symptom experience as like an internal storm over which they had no control. Such experiences required adolescents to embrace a variety of symptom management strategies, with adolescents reporting deliberate efforts to minimize their symptoms to external individuals. CONCLUSION: Co-occurring pain and mental health symptoms may be experienced in similar ways to individually experienced pain or mental health symptoms, but together, the experience may be both more difficult to manage and more socially isolating. SIGNIFICANCE: Adolescents with co-occurring chronic pain and mental health symptoms describe the experience as if there was a storm inside of them disrupting their sense of physical, emotional and social wellbeing. This inner chaos interferes with their self-identity and relationships with others. Challenges articulating their experiences, and negative encounters associated with their symptoms, further impact feelings of isolation and difficulties accessing support.

Use of a topical haemoglobin spray for oxygenating pressure ulcers: healing outcomes.

A published evaluation ( Tickle, 2015 ) of the use of a topical haemoglobin spray plus standard care in 18 patients with pressure ulcers showed that, following 4 weeks of treatment, the wound size reduced in 17 wounds and there was a progression toward healing in all 18. All but one of the wounds were over 2 months in duration at baseline. This article reports the results of the healing rates at 3 months of the 11 patients who continued to be treated with the haemoglobin spray. Nine of the 11 wounds healed, and 2 reduced in size by week 12 (i.e. 1 wound reduced from 30 cm(2) at baseline to 7 cm(2), while the other reduced from 6 cm(2) to 4 cm(2)). Of the 10 patients who were experiencing wound pain at baseline, 9 were pain free by week 8. Rapid elimination of slough was observed in all patients. The 82% healing rate achieved at 3 months and the fact that most patients continued to receive the same standard care as they had in the 4 weeks before recruitment into the evaluation increases the likelihood that the clinical outcomes observed here can be attributed to the haemoglobin spray. Topical haemoglobin shows promise in terms of its ability to accelerate healing in chronic pressure ulcers.

Use of topical haemoglobin on sloughy wounds in the community setting.

AIM: This evaluation aimed to determine whether the use of a haemoglobin spray solution expedited sloughy wound healing. METHOD: A descriptive evaluation was undertaken within a community setting exploring 25 patients presenting with sloughy healing and non-healing wounds, and the effects of 8 topically administered haemoglobin treatments over a 4-week period. Standard wound cleansing and dressing management were continued, with no changes to pre-evaluation regimens, and care being provided by the patients themselves or by a carer. Data were collected weekly with regard to primary outcomes of slough reduction, wound surface area reduction, patient ease of use (self-care), and overall product experience. RESULTS: At 4 weeks, all wounds demonstrated positive measured endpoints of slough elimination and continued wound-size reduction. Patients and carers found the product easy to use (self-caring) with an overall positive wound care experience. CONCLUSION: The administration of a haemoglobin spray solution on patients presenting with sloughy wounds resulted in positive healing outcomes of slough elimination and wound reduction alongside positive self-care and product satisfaction. Continued evaluation is recommended to build upon the evidence of this form of treatment.

150 patient experiences with a soft silicone foam dressing.

Pain, malodour and exudate from acute and chronic wounds can be catastrophic to the patient. Excessive exudate results in significant tissue damage to the wound bed and surrounding skin, reduces quality of life, and often requires costly specialist service input. Effective wound assessment and management including appropriate dressing choice is, therefore, paramount to ensure wound healing can take place in a timely manner. This observational evaluation explores 150 ward-based patients who presented with acute and chronic exuding wounds; it examines and evaluates the proposed benefits of the Cutimed(®) Siltec foam dressing range over a 4-month period in an acute hospital setting. The outcomes of the evaluation were exudate management, maceration reduction, atraumatic application and removal, non-adherence and patient experience. The evaluation highlights not only an overall positive improvement in exudate management and maceration reduction, non-adherence, atraumatic application and removal but also emphasises the importance of a positive patient experience in the wound-care journey.

Topical haemoglobin spray for diabetic foot ulceration.

UNLABELLED: The development and subsequent deterioration of diabetic foot ulceration (DFU) is a common occurrence across all healthcare divides, concerning all patient groups, age, gender and social environments. It increases demand on clinical resources and creates unnecessary hardship for patients. Chronic DFU is challenging to prevent and notoriously difficult to manage owing to the complex nature of the patient and the disease itself. The improvement of oxygenation to many chronic wound groups is gaining momentum across wound care; particularly in those wounds such as DFU that present with circulatory, oxygen-deficient scenarios. METHOD: A descriptive evaluation was undertaken in an acute clinical setting where a spray solution containing purified haemoglobin was used in a cohort of 20 patients who presented with chronic (>12 weeks) DFU. Standard wound care was undertaken by 18 health professionals with no changes to products, devices or practice before evaluation. All wounds received the addition of the product on eight set occasions over a 4-week period and the resulting data correlated in regards to the set outcomes of wound surface area reduction, ease of use, adverse events and patient acceptability. RESULTS: At 4 weeks all wounds had demonstrated positive wound reduction, there were no adverse events, all patients and clinicians found the product acceptable and easy to use. Interestingly, although not a set outcome, all wounds commenced the evaluation with wound-bed slough present and at 4 weeks 100% were deemed slough free. At a further 4-week review no patients wounds had regressed. CONCLUSION: The incorporation of a haemoglobin spray solution within this cohort of DFU resulted in a positive improvement in wound healing and slough elimination. Further work in this area is recommended to increase the evidence.

Principles of preventative foot care.

The lower extremities of the body, particularly the heel and ankle, are at risk of ulceration, skin tears and other forms of trauma. This is especially so in today's health-care environment, where society is faced with the challenges of an ageing population, alongside an increased incidence of diabetes, vascular insufficiency, obesity and dermatological conditions, all of which pose both clinical and economic challenges to health-care providers. Once established, damage to the foot can have a detrimental impact on the patient's overall wellbeing, often over extended periods of time, with some patients spending many years within the health-care system. Advanced wound care products tend to have a strong focus upon management of tissue damage, infection, maceration and the promotion of an optimum environment to facilitate the healing process. This clinician-patient collaboration product review challenges traditional ideals and explores the impact of using an adherent soft silicone foam dressing in maintaining skin integrity and preventing tissue damage in those high-risk patient groups.

Patient care and management: reduced skin integrity of the foot.

The development and deterioration of pressure ulcers are a frequent occurrence across all healthcare settings and specialties, posing daily challenges to the healthcare worker and unnecessary suffering to the patient. Reduced skin integrity occurs within those patients deemed high risk, particularly to the vulnerable areas such as the heel and ankle (American Physical Therapy Association (APTA), 1996). The incidence of pressure ulcers, alongside diabetes, vascular insufficiency and obesity, is on the increase, posing additional demands on current clinical resources; specialist clinics, debridement therapies and appropriate dressing management regimes. This article will focus on the heel and ankle in regards to reduced skin integrity and the positive introduction of an innovative dressing product as an adjunct to the overall care and management of this patient group.