Managing Painful Venous Ulcers

   Patients with venous ulcers often report pain, which may be continuous or intermittent and often is associated with dressing changes. The pain may be perceived as generalized in the leg, focused in the ulcer or periwound, or both. Inflammation and edema resulting from the underlying venous disease are key factors in the patient’s pain.

   Appropriate wound care combined with continuous use of compression can help reduce pain and improve outcomes in patients with venous ulcers. Although compression therapy is the standard of care for resolving these wounds and reducing pain, patients often resist this approach — willingness to wear compression stockings depends on the patient’s understanding that managing pain and discomfort will improve quality of life.    Strategies for pain reduction include the use of pain medications before dressing changes and dressings that are nonadherent, eliminate the need to manually cleanse the wound bed, and help reduce inflammation. An additional non-pharmacological strategy is to stimulate the opposite limb — eg, if the patient has pain in the left limb gaiter region, applying gentle massage to the right limb in the same anatomical location can help relieve the patient’s left limb pain. Stimulating the skin in the area of the wound also has been found to reduce pain. Slowly fanning air over the wound for a short period of time can change the sensations in the area, which can relieve pain. Once fanning is initiated and the patient reports or shows signs of feeling better, treatment can continue. This sensory-altering approach often improves the patient’s comfort level and allows the wound dressing and compression to be applied with minimal distress. These tactics often are used with cancer patients and in rehabilitation settings.

   A combination of strategies, appropriate wound dressings, and compression (when indicated) will help reduce patient wound pain and consequently improve quality of life.

 Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.

1. How to relieve pain without medicine. National Cancer Institute. Available at: http://rex.nci.nih.gov/NCI_Pub_Interface/Pain_Control/withoutmeds.html. Accessed September 15, 2008.