Managing pain

Overview – about pain

Pain is unfortunately a common feature for all lower leg wounds and swelling. Pain is a physical response to a stimulus and the amount of pain will depend on the type of wound, the presence of swelling or infection or simply the dressing used. We need to also recognise that fear or worry you have could make the pain worse and thus good conversations where concerns are discussed are an important part of pain management.

When pain is not managed properly it can lead to unresolved pain and depression. Studies of people’s experience tells us that pain can dominate their lives when they have leg ulcers and be very severe. This does not mean that this level of pain needs to be experienced.

Symptoms – understanding the type of pain you have

There are different types of pain which are described below:

1. Nociceptive pain. This could also be described as the normal type of pain. It is typically short-lived and due to an injury and may be described as sharp, throbbing, aching, dull and often continuous pain. This type of pain can be managed with Paracetamol or something stronger like Codeine. If this type of pain and the psychological impact is not managed, then the prolonged inflammatory response may create a situation called hyperalgesia, a heightened sensitivity that feels disproportionate to the injury; this type of pain may require medication that reduces neuropathic pain.
2. Neuropathic pain. This type of pain has altered sensations and may be described as shooting or burning, tingling, numb or stabbing. Neuropathic pain will not be reduced with Paracetamol and needs other medical management.
3. A combination or both Nociceptive and Neuropathic pain need a mix of medication.

The causes of pain

Pain is a natural response to injury. If the pain is not managed, it can be more difficult to resolve.

Diagnosis of pain

Understanding your symptoms and experience is critical to effective management.

Talk to your GP. Write a diary. This will help you to have a good discussion and help the doctor identify the best medication for you.

When describing your pain, think about:

• • When you have pain and for how long
  • What words you would use to describe the pain
  • Severity of pain such as scoring it from 1-10
  • Impact on your life and sleep
  • Factors that make the pain worse or less, your coping strategies
  • Are you feeling ‘heard’? If not, identify why and speak up or use a friend to speak on your behalf

Treatment of pain

Analgesia

Analgesia such as Paracetamol or Codeine is commonly given for ulcer or swelling related pain. But when thinking about your experience of pain, think also about your fears or care provided. Heightened anxiety will also increase pain. Actions to reduce anxiety will be very helpful.

Getting the right analgesia and treatment regime for you may not be easy and can feel a little bit of trial and error. That is why it is important to think and reflect on your pain, how you would describe it and what makes it worse.

Pain at dressing change

This can be a particularly scary time if your wound is painful. It is important that you have confidence in your healthcare professional; if you don’t then ‘anticipatory pain’ or fear will make the pain a lot worse. Make sure you or a friend can speak about your fears and identify which bit of the dressing change is of particular concern.

• If you have a dressing that is particularly painful, such as Iodine based, make sure you speak up and ensure that alternative products are used
• If dressing removal is painful, ask about non-stick products or remove the dressing yourself. Using warm water can help
• Bringing some control to this situation will help you

Compression therapy to reduce your pain

This may seem unlikely when you are in pain. However we know that compression therapy at the right dosage for your provides significant anti-inflammatory properties. As your leg or foot needs compression therapy to heal, your leg and wound will feel more comfortable with it than without. The compression dosage will impact directly on your pain and reduce wound inflammation. But good compression therapy needs to be applied well and to go hand in hand with analgesia.

Other ways to reduce your pain

Alongside medication and increased understanding of the cause and treatment options, there are other pain strategies to use:

• Walking with a friend or out in nature. Distraction and also fresh air helps
• Identifying fear or what helps / hinders can help conversations and improve our actions
• Mindfullness programmes. These have been shown to help in pain management and depression and anxiety
• Complimentary therapies such as massage

The outlook when you have pain

Pain needs to be managed and this requires a good conversation with your clinicians. Pain is a response to injury and so as the wound heals or the swelling reduces, pain will reduce also.

If it doesn’t or suddenly gets worse, seek help. Sudden pain can be a sign of infection.

Prevention of pain

Do not try and be stoic in the face of pain. Unmanaged pain only gets worse. Taking analgesia regularly stops the pain from becoming severe and more difficult to get rid of.

Harm – what can happen

Unmanaged or poorly managed pain is harmful. Inaction by practitioners means that:

• Pain can become entrenched
• Pain can stop the use of therapies such as compression which is critical to healing
• Unresolved pain ruins lives and in most cases, can be prevented

If you have any concerns about the treatment or care you are receiving, it is important to speak up.

Learn more about harm

Resources which may be useful for pain

This video has talks from Dr Amelia Swift at the Society of Tissue Viability on-line conference, 2021

• Pain and venous leg ulcers: mechanism, impact and management
• Non-pharmacological approaches to pain management