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.
Understanding the type of pain you have
- 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.
- 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.
- A combination or both Nociceptive and Neuropathic pain need a mix of medication.
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.
When discussing treatment for 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.
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
Some organisations you can contact for further information.
NHS Choices the official NHS website, which provides vital information and support about leg and foot signs and other symptoms.
Call 111 - for non-emergency medical advice
Find out more on the NHS Choices website
Accelerate Based in East London, Accelerate can accept national referrals from your GP / specialist to our world-class centre where we pioneer and trial experimental new treatments for chronic leg ulcers / wounds, lymphoedema and mobility challenges.
020 3819 6022
Find out more on the Accelerate website
Samaritans Samaritans are there 24 hours a day, 365 days a year providing emotional support to anyone in emotional distress. Call them free any time, from any phone.
Find out more on the Samaritans' website
Mind Mind is the UK’s leading mental health charity. They're there to make sure no one has to face a mental health problem alone you can call or text for free anytime.
0300 123 3393 or text 86463
Find out more on the Mind's website