Assessment and Treatment of Pain during Treatment of Buruli Ulcer

Abstract

BackgroundBuruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.MethodologyA mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed.Principal FindingsIn 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.ConclusionsProfessionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

Former Buruli Ulcer Patients’ Experiences and Wishes May Serve as a Guide to Further Improve Buruli Ulcer Management

“…Negative experiences of treatment were mostly associated with pain during dressings, physiotherapy or injections. This corresponds with the findings of de Zeeuw et al (2015) that pain management in BU needs more attention [30]. …”

“…Several negative aspects of BU management were identified. Many negative aspects were associated with pain, especially during dressings, injections, and POD activities, which confirmed recent reports on pain being common in BU [6, 30]. …”

Experiences of Pain and Expectations for Its Treatment Among Former Buruli Ulcer Patients

“…[12][13][14] The findings in this study corroborated previous research on HCPs perspectives on pain expression among BU patients, that some patients suppressed their pain, whereas others would exaggerate it. 10 It is possible that the patients who overtly expressed their pain by crying were perceived as exaggerating their pain. In addition, the notion that BU is a painless disease may also contribute to the idea that patients exaggerate their pain.…”

“…15 In the previous research, HCPs reported one factor which influenced their decision whether to prescribe pain medication was related to the affordability of the pain medication for the patient, as the patient had to cover the cost. 10 Nonpharmaceutical options could be one way in which pain in BU could be reduced without causing a financial burden on the patient.…”

“…9 Health-care professionals (HCPs) report difficulties in the assessment of pain and are hesitant to prescribe pain medication due to cost and side effects for the patient. 10 A guide was recently developed for the assessment of pain and (non)pharmaceutical interventions for BU. This guideline advocates assessment of pain using a combination of the Wong-Baker Faces Pain Rating Scale and clinical judgment in BU patients.…”