Pain during dressing removal is most commonly caused by adherent gauze sticking to the wound bed. When the dressing adheres firmly to the healing tissue, pulling it off disrupts newly formed granulation tissue and nerve endings, leading to pain. Proper wound care involves using non-adherent or appropriate secondary dressings to minimize trauma and discomfort during dressing changes. While allergic reactions, infection, and exudate are important considerations, they do not typically cause immediate pain specifically with dressing removal. Ensuring gentle dressing techniques and appropriate materials reduces tissue damage and pain.

Reference: Surgical Recall, 8th Edition.