Clinical hypnosis and pain management in sharp debridement of skin ulcers in immune-mediated inflammatory diseases

Wound sharp debridement is increasingly used for the manage­ment of skin ulceration in immune-mediated inflammatory disease. It consists of the removal of devitalised tissue (eg, necrotic tissue, slough, and hyperkeratotic cornified layers) and debris from the wound bed and margins. However, pain is associated with this procedure, and there is an absence of standardised approaches to manage this disabling symptom. Our experience from the immune-mediated inflammatory disease specialist wound-care clinic suggests that although injectable local anaesthesia might be effective during the intervention, the frequency of debridement during the initial stages of wound healing (once every 7 days, for approximately 2 months or longer) or when multiple ulcers coexist makes it less feasible. In patients with systemic sclerosis, the average healing time of digital ulcers is 76 days, with severe necrotic ulcers taking up to 281 days to heal, thus making the potential use of morphine challenging because of the increased risk of side effects and addiction. These drawbacks highlight the need for alternative non-pharmacological pain management options.