If a patient using negative-pressure wound therapy (NPWT) reports severe pain, which intervention is most appropriate?

• A. Change the wound filler
• B. Change the brand of NPWT unit
• C. Obtain wound cultures prior to dressing change
• D. Avoid placing of drainage tubing over bony prominences

Answer: (A)

Pain during NPWT is often due to an interface issue between the wound and the dressing. The wound filler (foam or gauze) transmits the negative pressure to the wound bed, so if it isn’t properly sized, contoured, or has rough edges, it can create high-pressure points, friction, or uneven suction that irritate tissue and cause severe pain. Replacing the wound filler with a properly cut, smoothly contoured filler helps distribute suction evenly, reduces localized irritation, and improves the seal, which typically alleviates the pain and allows effective therapy to continue.

After changing the filler, recheck the dressing seal and suction settings. The other options don’t address the underlying interface problem as directly: changing the NPWT unit brand doesn’t fix fit-related pain, obtaining wound cultures doesn’t relieve pain, and avoiding tubing over bony prominences is good practice but not the primary fix for sudden severe pain during therapy.