Article

Topical agents or dressings for pain in venous leg ulcers

School of Healthcare, University of Leeds, Baines Wing, Leeds, UK, LS2 9JT.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 11/2012; 11(11). DOI: 10.1002/14651858.CD001177.pub3

ABSTRACT

Venous leg ulcers are often painful, both during and between dressing changes, and during surgical removal of dead tissue (debridement). Dressings, topical creams and lotions have been promoted to reduce the pain of ulcers. Two trials tested a dressing containing ibuprofen, however, the pain measures and time frames reported were different. One trial indicated that pain relief achieved over 5 days with ibuprofen dressings could represent a clinically relevant reduction in pain. The other trial found no significant difference in the chance of pain relief, measured on the first night of treatment, for ibuprofen dressings compared with foam dressings. This trial, however, was small and participants were only followed for a few weeks, which may not be long enough to assess whether the dressing affects healing. There was evidence from five trials that a local anaesthetic cream (EMLA 5%) reduces the post-procedural pain of debriding leg ulcers but there was insufficient evidence regarding any side effects of this cream and its impact on healing.

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    • "Venous ulcers are more prevalent in women and older persons and the risk factors primarily include older age, obesity, previous leg injuries, deep venous thrombosis and phlebitis [3-7]. They are often recurrent and may sometimes persist from weeks to years, giving rise to the complications in form of cellulitis, osteomyelitis and at times malignant change [3] [8] [9] [10]. In spite of low overall prevalence, the refractory nature of these ulcers causes an increased risk of morbidity, mortality and a significant impact on quality of life [11] [12]. "
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    ABSTRACT: Venous ulceration is the most severe and debilitating outcome of chronic venous insufficiency in the lower limbs and accounts for 80 percent of lower extremity ulcerations. The morbidity caused by them has a serious impact on the qual-ity of life. Sustained venous hypertension, caused by venous insufficiency leads to venous ulceration. The diagnosis is mainly clinical but needs to be differentiated from other causes of lower limb ulcers. Doppler ultrasound is the diagnos-tic investigation. Treatment options for venous ulcers include conservative management, mechanical treatment, medica-tions, and surgical options. The goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. The achievement of good long term results depends on continuous care, ulcer care clinics, home health nursing and regular evaluation by the doctor. They have a crucial role to play for the amelioration of this common and morbid con-dition.
    Full-text · Article · Jan 2013 · Surgical Science
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    • "Venous ulcers are more prevalent in women and older persons and the risk factors primarily include older age, obesity, previous leg injuries, deep venous thrombosis and phlebitis [3-7]. They are often recurrent and may sometimes persist from weeks to years, giving rise to the complications in form of cellulitis, osteomyelitis and at times malignant change [3] [8] [9] [10]. In spite of low overall prevalence, the refractory nature of these ulcers causes an increased risk of morbidity, mortality and a significant impact on quality of life [11] [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Venous ulceration is the most severe and debilitating outcome of chronic venous insufficiency in the lower limbs and accounts for 80 percent of lower extremity ulcerations. The morbidity caused by them has a serious impact on the qual-ity of life. Sustained venous hypertension, caused by venous insufficiency leads to venous ulceration. The diagnosis is mainly clinical but needs to be differentiated from other causes of lower limb ulcers. Doppler ultrasound is the diagnos-tic investigation. Treatment options for venous ulcers include conservative management, mechanical treatment, medica-tions, and surgical options. The goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. The achievement of good long term results depends on continuous care, ulcer care clinics, home health nursing and regular evaluation by the doctor. They have a crucial role to play for the amelioration of this common and morbid con-dition.
    Full-text · Dataset · Jan 2013
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    ABSTRACT: Chronic leg ulcers affect approximately 1 – 3% of the population aged over 60 years in the U.K., Europe, U.S.A. and Australia (Briggs & Closs, 2003; Margolis et al., 2002). Prevalence increases with age (Margolis et al., 2002), rising from around 0.6% of the general adult population up to 2% - 5.6% of those aged over 65 years (Bergqvist et al., 1999). With today’s ageing societies (Parker, 2005), this condition will become an increasing problem in the future. Leg ulcers often take months or years to heal and frequently recur, becoming a life long chronic condition associated with prolonged ill-health, pain, restricted mobility and decreased quality of life (Chase et al., 2000; Walshe, 1995). When planning care for people with chronic leg ulcers, a health care model is required which not only addresses the need for evidence based wound care, but also pain management, symptom management and quality of life issues associated with the condition. Prevalence of pain associated with leg ulcers is reported as ranging from around 50% (Nemeth et al., 2003) to 80% (Hareendran, 2005) and leg ulcer pain is reported to decrease energy levels (Persoon et al., 2004), interrupt sleep (Edwards et al., 2005a), affect mood (Edwards et al., 2005a) and restrict mobility (Brown, 2005) and ability to manage normal work (Edwards et al., 2005a). Mobility is often further constrained by the need to wear bulky, multilayered bandages, limiting the type of footwear and clothing able to be worn. Reduced mobility impacts on independence in activities of daily living and productivity. For example, Abbade et al. (2005) found 49.2% of patients had a functional disability impacting on daily activities and work and Persoon et al.’s (2004) review of 37 studies found restraints in work and leisure activities were one of the major limitations imposed by leg ulcers. Pain, limited mobility and embarrassment associated with leg ulcers often leads to social isolation (Ebbeskog & Ekman, 2001; Persoon et al., 2004). The combination of pain, restricted mobility and social isolation in turn contributes to a negative impact on psychological health (Ebbeskog & Ekman, 2001; Persoon et al., 2004); such as depression and anxiety (Jones et al., 2006). In addition, the long term nature of the disease can lead to uncertainty, disappointment, loss of hope, or despair (Ebbeskog & Ekman, 2001). Problems with poor understanding of the cause and treatment of the condition have been noted (Chase et al., 2000), leading to feelings of powerlessness, lack of ownership and apathy with regard to management strategies. Not surprisingly, measures of quality of life in people with chronic leg ulcers have generally found significantly lower quality of life scores than in the general population (Franks et al., 2003; Jull et al., 2004).
    No preview · Article · Jan 2008
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