Lower extremity changes, pain, and function in injection drug users

Persons who have injected drugs are highly susceptible to a life-long, debilitating condition of the legs called chronic venous insufficiency (CVI). CVI may affect a person's ability to function. The purposes of this study were to examine (a) the functional relationship between CVI severity, pain, and behavior; and (b) the extent to which pain mediates the relationship between CVI severity and functional behavior for persons with a history of injection drug use. The 100 participants had a history of injection drug use and were recruited from a medical clinic and a methadone treatment clinic. Participants responded to a questionnaire that contained demographic, health history, drug history, pain and functioning components. Their legs were examined from the knees to the feet for clinical manifestations of CVI. Pain and functional behavior were monotonically related to severity of CVI. Path analysis showed leg pain as a mediator of the relationship between CVI and behavioral functioning controlling for the effects of other chronic diseases. Treatment center counselors need to be aware of leg changes that occur with injected drugs, realize these changes may affect many aspects of functioning and cause pain, and encourage clients to obtain medical assistance for treatment of their legs.