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Topical agents or dressings for pain in venous leg ulcers
1Centre for the Analysis of Nursing Practice (CANP), Leeds Community and Mental Health Trust, Meanwood Park Hospital, Leeds, West Yorkshire, UK, LS6 4QB. canp@lmu.u-net.com
Background:
Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings to reduce the pain both during and between dressing changes.
Objectives:
To assess the effectiveness of dressings, local anaesthetics/analgesics for pain relief in venous leg ulceration.
Search Strategy:
Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.
Selection Criteria:
All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.
Data Collection And Analysis:
Eligibility for inclusion was confirmed by two reviewers who independently assessed the all potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.
Main Results:
No trial evaluated interventions for persistent pain. Three trials compared a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. All 3 trials reported a significant difference in pain in favour of EMLA, however, one of the trials favoured placebo in terms of number of ulcers healed at the end of the trial and another trial noted an increased incidence of burning and itching with the use of EMLA.
Reviewer'S Conclusions:
EMLA may provide pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing and the incidence of itching and burning is unclear. Research is required to address questions such as the benefits of leg ulcer debridement and the impact of EMLA on healing and the incidence of burning and itching. There were no trials addressing the treatment of persistent pain and further research is warranted.