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 pain-intensity visual analogue scale. The significance of the observations was tested using either the Mann-Whitney U-test (unpaired observations) or the Wilcoxon signed-rank 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. 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.