What is new in our understanding of pressure injuries: the inextricable association between sustained tissue deformations and pain and the role of the support surface

This paper first provides an overview of the contemporary research findings and latest aetiological discoveries concerning the prevention of pressure injuries (PIs) as reported in the 2019 version of the Prevention and treatment of pressure ulcers/injuries: clinical practice guideline (known as the International guideline), including, where relevant, through the new prism of the coronavirus disease 2019 (COVID-19) pandemic. Second, the biomechanical principles of PI prevention (PIP) through minimisation of tissue deformation levels are explained from a support surface design perspective. Third, and related to the second, the association between alleviation of sustained tissue deformations and mitigation of PI-risk-related or PI-related pain are reviewed with a focus on the role of the support surface. Fourth, and last, a discussion of the current PI aetiology theory is presented from a clinical practical perspective, using one documented patient testimony and two additional patient case stories, which are used here to analyse the complex interlinks between the known aetiological factors in PIs – discomfort and pain.