Topical therapy for pain management in malignant fungating wounds: a scoping review

• Autor(a) principal: Ferreira, Suzana Aparecida da Costa
• Data de Publicação: 2022
• Outros Autores: González, Carol Viviana Serna, Thum, Magali, Faresin , Adriane Aparecida da Costa, Woo, Kevin, Santos , Vera Lúcia Conceição de Gouveia
• Tipo de documento: preprint
• Idioma: eng
• Título da fonte: SciELO Preprints
• Texto Completo: https://preprints.scielo.org/index.php/scielo/preprint/view/4518
• topic: Neoplasia; Ferimentos e Lesões; Gestão da dor; Cuidado Centrado no Paciente; Administração Tópica; Revisão; Enfermagem; Enfermagem baseada em evidências; Enfermagem oncológica; Neoplasms; Wounds and injuries; Pain Management; Patient-Centered Care; Topical Administration; Nursing; Evidence-based Nursing; Oncology Nursing; Review; Heridas y Lesiones; Manejo del Dolor; Administración Tópica; Enfermería; Enfermería Oncológica.; Revisión; Neoplasia; Cuidado centrado en el Paciente

Aims and objectives: To map and synthesize the existing literature on topical therapies for Malignant Fungating Wounds  pain management and the gaps involved. Background: Most cancer patients with Malignant Fungating Wounds suffer from wound-related pain, affecting their quality of life. Unfortunately, even though pain is a relevant symptom in cancer and palliative care, little is currently known about topical treatments' availability and impact on pain management. Design: A scoping review following JBI® methodology Methods: Searches were performed in CINAHL, LILACS, Embase, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR, and gray literature, in English, Portuguese and Spanish, with no time limit. Two authors independently reviewed all citations and a third was called in case of divergence, and studies in adults with Malignant Fungal Wounds reporting topical pain interventions were included. In addition, a data extraction tool for synthesis and thematic analysis was developed. This study followed the PRISMA-ScR Checklist. Results: 70 publications were selected from 796 records retrieved from databases. The studies mainly included non-systematic reviews and case studies with only six clinical trials. According to the narrative synthesis, twenty therapies were identified, including the use of wound dressings (58.6%), analgesic drugs (55.7%), topical antimicrobials (25.7%), skin barriers (15.7%), cryotherapy (5.7%), and Negative Pressure Wound Therapy (4.3%). Therapies were recommended to be applied to the wound bed or the periwound skin. In 68.5% of the studies, a standardized assessment for pain was not described.  Conclusions: Topical therapies applied to Malignant Fungating Wounds or periwound areas had been examined for pain management. However, their effectiveness was analyzed in a few interventional studies, indicating the need for further primary studies to inform evidence-based practice.  Implication for Practice: Highlighted topical therapies for clinical practice consideration are opioids, anesthetics, and antimicrobials, with positive results described in randomized clinical trials. This study did not include patients.