Download

Nursing Best Practice Guideline
C. PAIN
Recommendation • 13
Assess Pain (Level of Evidence = C – RNAO Consensus Panel, 2004 )
Recommendation • 14
Pain may be a feature of both venous and arterial disease, and should be addressed.
(Level of Evidence = B)
Recommendation • 15
Prevent or manage pain associated with debridement. Consult with a physician and
pharmacist as needed. (Level of Evidence = C – RNAO Consensus Panel, 2004)
39
Discussion of Evidence:
Research results consistently indicate that clients with venous leg ulcers can experience
considerable pain (RCN, 1998), and that a significant proportion of clients with venous leg
ulcers report moderate to severe pain. Sibbald (1998a) reports that 76 percent of severe
venous ulcers are painful. In a study cited by Kunimoto et al. (2001), pain in three distinct
locations was reported by clients – within ulcers, around ulcers, and elsewhere in the leg. Pain
often increases when the limb is in a dependent position.
Assessment of pain is complex, but a structured discussion and frequent re-assessment are
important (CREST, 1998a; SIGN, 1998). The importance of pain management in venous leg ulcer
clients is often cited in the literature, yet in one particular study, 55 percent of district nurses
did not assess the clients’ pain.
Pieper et al. (1998) identified a need for better control of venous leg ulcer pain so people felt
more confident and positive about treatment and could reduce activity restrictions,
complementing the observation by Liew et al. (2000), that pain can significantly reduce
clients’ quality of life (see Recommendation 6).
Although utilization of a pain assessment tool is strongly recommended in the literature, no
research evidence could be identified that examined the use of a pain assessment method
specifically designed for clients with venous leg ulcers, or compared different methods of