Venous Leg Ulcers: Is Pain a Problem?

Abstract

Objective: To employ standardized techniques to measure and characterize the pain associated with leg ulcers of defined causes. Methods: Patients attending leg ulcer clinics were interviewed by one research nurse using a structured questionnaire. Ulcers were classified as venous, arterial or mixed depending on the clinical assessment and ankle-brachial systolic pressure index. Pain was assessed objectively using two validated instruments for scoring pain: a verbal rating scale and a painintensity visual analogue scale. The significance of the observations was tested using either the Mann-Whitney V-test (unpaired observations) or the Wilcoxon signedrank test (paired observations). A profile of the quality of pain was obtained using the short-form McGill Pain Questionnaire (SF-MPQ). Quality of life was assessed using the COOP Chart System. Patients: We assessed 38 patients with venous ulcers, three patients with mixed arterial/venous ulceration and 10 patients with arterial disease. Main outcome measures: Pain scores on verbal rating scales and visual analogue scales. Results: Venous leg ulcers are painful. Although pain scores are greater in arterial ulcers, most patients with venous ulceration suffer at least moderate pain. Night pain disturbed sleep in 73% of all patients and pain affected mood in more than 50%. Dressing changes exacerbated pain. Correspondence and offprint requests to: Dr S. M. Burge, Department of Dermatology, The Churchill, Old Road, Headington, Oxford OX3 7LJ, UK. Conclusions:Pain reduces the quality of life in most patients with leg ulcers. Pain control is an essential consideration in all patients with leg ulcers.

Can venous and arterial leg ulcers be differentiated by the characteristics of the pain they produce?

“…This is difficult to explain, but could be because of a difference in night time pain between the two groups. Noonan and Burge (1998) demonstrated a statistically significant difference in night pain scores for people with arterial vs. venous ulcers. Those with arterial wounds had more pain at night.…”

Development of an Ibuprofen‐releasing biodegradable PLA/PGA electrospun scaffold for tissue regeneration

“…The majority of chronic ulcers are managed in the community and from the point of view of the patient the day-to-day problems are twofold-pain on dressing changes and the failure of ulcers to heal. Patients with chronic wounds often experience pain on dressing changes (Noonan and Burge, 1998) and the removal of the dressing itself can be associated with an inflammatory reaction. The reasons why chronic wounds fail to heal are several and interrelated-wounds are often poorly vascularized and hypoxic, commonly inflammed, often infected and as a consequence aggressive and resistant to healing.…”

Association of Pain Level, Health and Wound Status in Patients with Chronic Leg Ulcers

“…through inflammatory processes from the injury), nerval irritation (e.g. by ischaemia, infection, or inflammation), or complications such as infection, skin maceration, contact dermatitis, or wound treatment (4,5). The objectives of this research are to evaluate the level of suffering that patients endure because of their ulcer-related pain, and to evaluate whether and how this pain is treated.…”