Pain in persons with chronic venous leg ulcers: A systematic review and meta‐analysis

Leren, Lena; Johansen, Edda; Eide, Hilde; Falk, Ragnhild Sørum; Juvet, Lene Kristine; Ljoså, Tone Marte

doi:10.1111/iwj.13296

Cited by 46 publications

(45 citation statements)

References 63 publications

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“…However, this group showed a statistical difference in painkillers' use, normally observed in this clinical picture (29) . The results suggest that patients who received adjuvant LLLT benefited from the analgesic effects provided by the treatment and showed a higher number of healed lesions, in line with previous studies (29)(30)(31) .…”

Section: Discussionsupporting

confidence: 90%

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

et al. 2021

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Objectives: to evaluate the effects of venous ulcer healing in patients after six months of conventional treatment and adjuvant low-power laser therapy. Methods: prospective cohort study nested in a randomized clinical trial with 38 patients, allocated into an intervention group (conventional treatment and adjuvant laser therapy) and a control group (conventional treatment). Patients were followed up as outpatients, sociodemographic and clinical variables were collected, and indicators of the outcomes Wound healing: secondary intention (1103) and Tissue integrity: skin and mucous membranes(1101) of the Nursing Outcomes Classification. Generalized estimating equations, Kaplan-Meier tests, and robust Poisson regression were used in the analysis. Results: the clinical indicators Decreased wound size and Scar formation showed a statistically significant difference in the intervention group, higher number of healed wounds, lower rate, longer time to relapse. Conclusions: laser therapy adjuvant to conventional treatment returned better results in healing and lower recurrence rates after six months of intervention.

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Section: Discussionsupporting

confidence: 90%

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

et al. 2021

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“…The consequences of non-adherence to treatment recommendations include chronicity of VLUs, increased recurrence rate ( Finlayson et al, 2018 ), infection ( Bui et al, 2019 ) and secondary squamous cell carcinoma ( Reich-Schupke et al, 2015 ). Disease progression ( Meulendijks et al, 2020 ) and associated complications exacerbate wound pain ( Leren et al, 2020 ), increase wound exudate, and reduce patients’ mobility, which in turn contributes to disease progression ( Meulendijks et al, 2019 ), leads to premature disability ( Mallick et al, 2020 ), and inadvertently influences patients’ quality of life ( Barnsbee et al, 2019 ). Management of these complications require complex interventions and highlights the need for optimal care for this underestimated condition.…”

Section: Introductionmentioning

confidence: 99%

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

et al. 2021

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The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.

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“…The present study focusses on ulcer‐related background pain defined as pain related to wounds experienced in everyday life (other than procedural/operative pain) (Leren et al, 2020). This type of pain is highly prevalent and reduces quality of life (Olsson et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…This type of pain is highly prevalent and reduces quality of life (Olsson et al, 2019). A recently published systematic review and meta‐analysis reported that up to 80% of persons with chronic wounds experience mild to moderate pain (mean pain intensity of 4 out of 10, 95% CI 3.5, 4.5) between dressing changes (Leren et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with ulcer‐related pain in persons with chronic leg ulcers—an explorative study

Leren

Johansen

Eide

et al. 2021

Journal of Clinical Nursing

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Aims and Objectives The aims of this study were to explore the prevalence of background pain and identify demographic, clinical and psychosocial factors associated with moderate to severe background pain in persons with leg ulcers. Background All chronic leg ulcers are potentially painful. Research indicates that 80% of persons with chronic leg ulcers experience wound‐related background pain. However, studies on factors associated with pain have small samples and findings are inconclusive. Design Exploratory cross‐sectional study. Method This quantitative study recruited persons with chronic leg ulcers (N = 252) from two wound care clinics using consecutive sampling method. Data were obtained through screening interview, clinical examination and questionnaires. Logistic regression with stepwise backwards elimination was used to identify factors associated with moderate to severe background pain. The STROBE checklist for cross‐sectional studies was used for reporting this study. Results Background pain was reported by 64% of the participants. Inferential statistical analyses suggest that between 58% and 69% of persons with chronic leg ulcers suffer from this type of pain. Factors associated with moderate to severe pain were older age, female gender, reduced sleep quality and diminished health status. In the final model, reduced sleep quality increased the likelihood of having moderate to severe pain in persons with good health status while not in persons with diminished health status. Conclusion Ulcer‐related background pain is common in persons with chronic leg ulcers. Older females reporting insomnia symptoms also had increased risk of moderate to severe ulcer‐related background pain. These participants also perceived their health status to be better. Relevance to clinical practice This study demonstrates that ulcer‐related background pain and associated factors needs more attention in clinical practice. Furthermore, nurses and other healthcare professionals should integrate biopsychosocial strategies to assess and manage ulcer‐related background pain.

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Pain in persons with chronic venous leg ulcers: A systematic review and meta‐analysis

Cited by 46 publications

References 63 publications

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

Prevalence and factors associated with ulcer‐related pain in persons with chronic leg ulcers—an explorative study

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