A descriptive study of ulcer-related pain characteristics and management

Background: Chronic leg ulcers are hard-to-heal wounds located below the knee and are increasingly prevalent in the Western population. Irrespective of pathology, chronic leg ulcers are associated with a negative impact on physical and psychosocial function and health status. While all chronic leg ulcers are presumed potentially painful, the prevalence of ulcer related pain is not clearly documented. A thorough description of pain characteristics, impact and management is not present in the available literature. Furthermore, little attention is paid to persistent pain at rest and between ulcer-related procedures such as ulcer-related background pain. Aim: This thesis aimed to explore the prevalence, characteristics, and management of ulcer-related background pain, as well as factors associated with moderate to severe ulcer-related pain. Materials and methods: The aims were addressed through a systematic review (Paper I) and a clinical study (Papers II and III). The systematic review was conducted to synthesize available data from both descriptive and effect studies, using the systematic review methodology guided by PRISMA. Random-effects meta-analyses—both overall and stratified by study design—were performed for pain prevalence and pain intensity. A univariable random-effects meta-regression analysis was performed to explore sources of heterogeneity. The clinical study used an exploratory cross-sectional design. Persons with chronic leg ulcers were recruited from two wound care clinics using the consecutive sampling method. Data was obtained through screening interviews, clinical examinations and questionnaires. In Paper II we analysed data from persons with chronic leg ulcers (N = 252) to establish the prevalence of ulcer-related background pain. Logistic regression with stepwise backwards elimination was used to identify factors associated with moderate to severe background pain. In Paper III descriptive analyses were used to explore characteristics (i.e., intensity, localization, temporal pattern, interference) of ulcer related background pain and pain management in participants who reported ulcer related background pain (N = 121). Main results: In the systematic review and meta-analyses we found a pooled prevalence of ulcer related background pain of 80 % (95% CI 65-92%) in persons with chronic venous leg ulcers. The pain intensity was moderate in average (NRS 4 [(95% CI 3.4-4.5]). The systematic review further confirmed the scarcity of descriptions o