PATIENTS SUFFERING FROM LEG ULCERS

Qualitative and Quantitative Designs for Investigating the Clinical Implications of Patients Suffering from Leg Ulcers



Abstract

Ulcers of the lower extremity are very common in the older population and require specific treatment based on the etiology of the lesions. Venous stasis ulcers are the most common (60% of all lower extremity ulcers), followed by neuropathic ulcers (secondary to diabetes mellitus and other conditions that cause nerve damage and decreased sensation), ischemic ulcers (secondary to arterial insufficiency), and then miscellaneous causes (e.g., trauma, autoimmune). Using the qualitative and quantitative designs for investigating the clinical implications of the topic this prospective case series examined ten patients with painful chronic venous leg ulcers who were treated for six dressing changes with a foam dressing releasing ibuprofen (Biatain-Ibu) and appropriate compression bandaging.

Introduction and Background

Over the past 15 years numerous studies have provided evidence that people with chronic venous leg ulcers (CVLU) have a reduced health-related quality of life (HRQoL). Effects on the quality of life of this client group have been investigated using both generic and disease-specific assessment tools and qualitative approaches that describe the patient's experience.

Leedy & Ormrod (2005) mention the negative effect on HRQoL in leg ulcer patients is caused by many inter-related factors including wound odour, exudate leakage, skin problems, pain, restricted mobility, lack of sleep and increased frequency of dressing and bandage changes (Hopkins, 2004). For those with non-healing ulcers this may lead to loss of independence, lack of energy, mood changes and social isolation. For some this may result in depression, loss of self-esteem, anger and high levels of anxiety.

Wound pain is consistently reported by patients as the most prominent feature of CVLU. The prevalence of pain in CVLU has been reported to be as high as 64%. Venous leg ulcer pain can be persistent, even at rest, or may be specifically related to, and exacerbated by, wound dressing-related procedures (Leedy & Ormrod, 2005).

There are two physiological types of pain: nociceptive and neuropathic. Nociceptive pain is defined as the normal physiological response to a painful stimulus. Soft tissue injury associated with nociceptive pain causes inflammation and stimulation of peripheral nerve endings. The resulting hypersensitivity means that even minor stimulation can cause intense pain (Leedy & Ormrod, 2005). Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system and may be caused by nociceptive pain, ischaemia, diabetes or trauma that has damaged the peripheral nervous system and altered the pain response.

An individual's experience of wound pain is complex and is influenced by a wide range of factors unique to them. Pain has a strong emotional dimension that is influenced by previous experience (Hopkins, 2004). Therefore it is no surprise that reduction of pain is frequently cited as the highest treatment priority from the patient's perspective. The importance of adequate pain management associated with chronic wounds is now becoming recognised in clinical practice because it can significantly improve patient's HRQoL and may indirectly promote healing by improving appetite and sleep (McDowell & Newell, ...