Wound pain & odor

Goals are to control symptoms (pain, odor) manage infection, exudate and preserve dignity. Involve wound care nurse. Debride necrotic tissue to aid in healing, odor and absorption of opioid for pain.


may be constant or incident with dressing change or movement

systemic opioids may not control pain adequately

opioid receptors present on open wounds and fungating tumors

Topical Opioids:

Methadone powder 100mg in 10g of inert wound powder (1% concentration)

Use 2.5g of mix per 15cm2 (3inch2) of surface area (aprox.)

Apply as last step prior to dressing

Shake on wound or tumor – completely cover open tissue with a thick layer of powder

Ensure undermined tissue surface is covered with mix

If pain relieved, patient drowsy – reduce systemic opioid

May use morphine in hydrophilic gel at 1% concentration if methadone unavailable


For dressing change pain: see Incident pain


Flagyl powder sprinkled over the wound (after the topical opioid). Topical flagyl gel (1%) if using morphine in gel.

Put odor-control cat litter on tray under patient’s bed, essential oils (peppermint, vanilla, etc…) used to mask odor (ensure scent is acceptable to patient

Odor-control dressings