Tuesday, August 2, 2022

Venous Leg Ulcer Pain Relief

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Venous Leg Ulcer Causes

Venous Stasis Ulcer Treatment

A venous leg ulcer is caused by low blood circulation due to damaged veins in your legs.

There are two main types of blood vessel:

  • arteries oxygen-rich blood is pumped from your heart, through your arteries, to the rest of your body
  • veins blood is returned to the heart through the veins once the oxygen has been removed

Vein problems occur when the valves inside the veins stop working properly.

In a healthy vein, blood flows towards the heart. Blood is prevented from flowing backwards by a series of valves that open and close to let blood through. If the valves weaken or are damaged, for example, following a deep vein thrombosis, the blood can flow backwards.

This may cause varicose veins visible on the surface of the leg, or the damage may lie in the deep veins, hidden from view. Pressure inside these veins is increased and this can damage the skin.

The constant high blood pressure in your legs causes fluid to leak from the veins. The fluid causes swelling and damages the skin, which becomes hard and inflamed, leading to an ulcer.

Ten Top Tips On Leg Ulcers

  • Always perform a thorough assessmentAsk about symptoms and how long the patient has had problems. Examine the lower legs. Most patients should have a Doppler ultrasound to calculate the ankle brachial pressure index to see if there are problems with blood supply to the lower leg. This test should be undertaken as early as possible but certainly within a few weeks of the patients first appointment.
  • Use compression to treat venous hypertension and lymphoedemaIf the leg ulcer is because of poor venous return or lymphoedema and the patient has an adequate blood supply to their lower limb, graduated compression therapy is likely to be a very efficient healing method. It is best to think of compression in terms of dose. The recommended dose delivers 40mmHg at the ankle. Compression that delivers less than this will usually be less effective in promoting healing.
  • Always involve the patient when deciding on the best type of compressionIf a patients wound is not too wet they may prefer compression hosiery to bandaging. But if their legs are tender, bandaging might be more comfortable. Including the patient in the decision-making increases the chance of them coping better with their compression therapy.
  • Tell patients to regularly wash their legs and feet and use moisturiserIt is important to maintain good hygiene of both the leg and foot to reduce the risk of infection. Regular use of bland moisturising creams and ointments will protect the skin and its elasticity.
  • What Are The Causes Of A Venous Leg Ulcer

    Venous leg ulcers develop because of problems with the blood circulation in your leg veins. Valves in your legs help to push blood from your legs and feet back up towards your heart. If these valves become damaged, the blood pools in the leg veins, causing pressure symptoms and skin changes.

    Often an ulcer will develop after a minor injury to your leg, and because of blood circulation problems, the wound fails to heal.

    Youre more at risk of developing a venous leg ulcer if you:

    • are overweight
    • have a history of deep vein thrombosis
    • have had a previous venous leg ulcer
    • are aged over 60.

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    Treating The Ulcer Medically

  • 1Visit your doctor to get information about your ulcer. Treatment for an ulcer depends on whether it is an arterial ulcer or a venous ulcer . Treating an arterial ulcer is often a matter of urgency. So it is important to first call your doctor and get their professional advice before trying to heal an ulcer on your own.XResearch source
  • Your doctor will first examine the wound and then take blood pressure readings at the ankle and arm to measure the blood flow in your lower leg.XResearch source
  • Venous leg ulcers are more common than arterial ulcers, making up over 90% of all cases.XResearch source
  • 2Consider surgery to treat an arterial leg ulcer. A blocked or narrowed artery is the most common cause of an arterial leg ulcer. This blockage reduces the amount of blood that can flow to tissue in your leg. Poor blood flow can deprive the tissue of oxygen and nutrients, possibly leading to the death of the tissue. For this reason, treating an arterial leg ulcer is an urgent matter.XResearch source
  • Your doctor may refer you to a vascular surgeon who may perform surgery either to clear out the blocked artery or to add a new route for blood to flow along and bypass the blockage.
  • While your external wound may heal in as little as 2 weeks after the surgery, it may take several months for the underlying tissues to fully heal.XResearch source
  • You should clean and dress the ulcer under the supervision of a medical professional.
  • How Are Leg Ulcers Diagnosed

    Venous Ulcers
    • A physical examination is the most common way to diagnose it.
    • A doppler machine can also be used to diagnose leg ulcers based on the blood supply to your legs.
    • In some cases, your doctor may refer you to a vascular specialist if he is not able to confirm your condition.

    Once you are diagnosed with leg ulcers, you tend to look for different options to treat the condition. And what could be better than being able to do so naturally? Listed below are some of the best home remedies that can help you in treating leg ulcers naturally.

    What You Have To Do
  • Take an aloe vera leaf and cut it slightly.
  • Scrape off the jelly-like substance from the leaf.
  • Apply the gel directly to the ulcers on your leg.
  • How Often You Should Do This

    Do this 2-3 times daily.

    Why This Works

    Aloe vera is a therapeutic herb that is widely used to treat various ailments. It is extremely effective in healing leg ulcers as it not only inhibits the growth of bacteria but also prevents further infection . It contains compounds like anthraquinones and certain hormones that are said to render wound healing properties to it .

    What You Have To Do
  • Take a little organic honey on your fingertips.
  • Apply it gently to the open ulcers on your leg and leave it on.
  • You can wash it off with water after 10 to 15 minutes.
  • How Often You Should Do This

    Do this at least 2-3 times daily.

    Why This Works
    What You Have To Do
  • Grind the gotu kola leaves with enough water to form a thick paste.
  • Wash it off.
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    Can Venous Leg Ulcers Be Prevented

    There are several ways to help prevent a venous leg ulcer in people at risk, such as:

    • wearing compression stockings
    • losing weight if you’re overweight
    • exercising regularly
    • elevating your leg when possible

    This is particularly important if you’ve previously had a leg ulcer once a leg has suffered a venous ulcer, you’re at risk of further ulcers developing within months or years.

    Read more about preventing venous leg ulcers.

    Caring For Venous Ulcers

    Venous ulcers need proper care and treatment to prevent infection and to heal. It’s important to have any venous ulcers checked right away by your healthcare provider.

    Treatment may require focusing on the circulatory or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:

    • Clean the wound regularly

    • Apply a dressing to the ulcer

    • Avoid products that cause skin sensitivity

    • Wear compression stockings to prevent blood from pooling in the legs and to speed healing

    • Apply an antibacterial ointment or another topical medicine to prevent or treat an infection

    • Take oral antibiotic medicines to prevent or treat an infection

    • Have allergy testing done

    Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin.

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    What Can Cause Leg Ulcers

    Venous hypertension / insufficiency the most common cause of poor healing on the lower leg is venous hypertension. This is when the veins struggle to take the blood back up the leg, so the blood can pool at the ankle creating pressure in your veins

    Peripheral arterial disease another reason why our lower leg wound might not be healing is because not enough blood is getting down to our feet to heal the wound. This is then the opposite of the problem described above with veins.

    Diabetes peripheral arterial disease is a known complication of diabetes, which can lead to developing a leg ulcer or diabetic foot ulcer.

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    Criteria For Considering Studies For This Review

    Leg Ulcers | Venous Leg Ulcers Symptoms and Treatment

    Types of studies

    Trials were eligible for inclusion if the following criteria applied:

    • they were randomised controlled trials that evaluated dressings and/or topical analgesics/anaesthetics used to relieve the pain associated with venous leg ulceration. Either the allocation of participants had to be described as randomised, or it had to be evident that the intervention was assigned at random
    • crossover trials were eligible, but only data from the first period were extracted in order to avoid carryover effects
    • there was no restriction on the basis of language or publication status.

    Trials were excluded if the evaluation of pain was not the primary aim, or if the pain was measured as a feature of the dressing .

    Types of participants

    Trials that included a mixture of people with the following ulcer aetiologies: arterial disease mixed aetiology neuropathic and diabetes were included, if the outcomes for people with venous ulcers were reported separately, or the original data were available.

    Trials were excluded if the trial sample comprised people with infected ulcers at baseline, as the nature of the pain associated with infection may differ from the pain of leg ulceration.

    Types of interventions

    The primary intervention was the application of a topical analgesic/anaesthetic or dressing with the aim of relieving the pain associated with venous leg ulceration.

  • local anaesthetics
  • non steroidal antiinflammatory gels
  • capsaicin
  • opioids.
  • film dressings
  • Primary outcomes

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    How Venous Leg Ulcers Are Treated

    Most venous leg ulcers heal within 3 to 4 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. However, some ulcers may take longer to heal, and a very small number never heal.

    Treatment usually involves:

    • cleaning and dressing the wound
    • using compression, such as bandages or stockings, to improve the flow of blood in the legs

    Antibiotics may also be used if the ulcer becomes infected, but they don’t help ulcers to heal.

    However, unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer recurring after treatment. Underlying causes could include immobility, obesity, previous DVT, or varicose veins.

    How Long Does It Take For A Stomach Ulcer To Heal

    Its not that easy to treat a stomach ulcer.

    There is no specific time limit and recurrences after treatment are frequent.

    Each individuals reaction to medication is also very different, which is why it is impossible to define a healing time.

    Its a long way to go but changing your diet by selecting beneficial foods and adding some targeted supplements can help you overcome this condition.

    Try to be proactive and take action both to treat the ulcer and to prevent its recurrence.

    This will save you time and comfort.

    * Read more:

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    Other Types Of Leg Ulcer

    Other common types of leg ulcer include:

    • arterial leg ulcers caused by poor blood circulation in the arteries
    • diabetic leg ulcers caused by the high blood sugar associated with diabetes
    • vasculitic leg ulcers associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus
    • traumatic leg ulcers caused by injury to the leg
    • malignant leg ulcers caused by a tumour of the skin of the leg

    Most ulcers caused by artery disease or diabetes occur on the foot rather than the leg.

    Page last reviewed: 11 January 2019 Next review due: 11 January 2022

    Topical Agents Or Dressings For Reducing Pain In Venous Leg Ulcers

    EMF » Chronic venous leg ulcer

    Venous leg ulcers are often painful, both during and between dressing changes, and during surgical removal of dead tissue . Dressings, topical creams and lotions have been promoted to reduce the pain of ulcers. Two trials tested a dressing containing ibuprofen, however, the pain measures and time frames reported were different. One trial indicated that pain relief achieved over 5 days with ibuprofen dressings could represent a clinically relevant reduction in pain. The other trial found no significant difference in the chance of pain relief, measured on the first night of treatment, for ibuprofen dressings compared with foam dressings. This trial, however, was small and participants were only followed for a few weeks, which may not be long enough to assess whether the dressing affects healing. There was evidence from five trials that a local anaesthetic cream reduces the post-procedural pain of debriding leg ulcers but there was insufficient evidence regarding any side effects of this cream and its impact on healing.

    There is some evidence to suggest that ibuprofen dressings may offer pain relief to people with painful venous leg ulcers. EMLA appears to provide effective pain relief during the debridement of venous leg ulcers. Further research should consider standardised pain assessment methods and assess both the effect on ulcer healing and the impact of long term use of these treatments.

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    Pain Management For Venous Ulcers

    Venous ulcers are open skin sores that can affect any area of the body but most often occur on the legs. It is estimated that about 1% of Americans have venous ulcers. Theyre more common in older people, particularly women, and more likely to occur with people who have varicose veins. Other types of people who have an increased chance of getting a venous ulcer include:

    • Those who have suffered previous leg injuries.
    • Those who smoke.
    • Those who are overweight or obese.
    • Anyone with a circulation problem, such as blood clots or phlebitis .

    Venous ulcers are sometimes called venous insufficiency ulcers, stasis leg ulcers, and venous leg ulcers.

    In This Article:

    Description Of The Condition

    Leg ulceration is estimated to have a point prevalence in Europe and Australia of 0.1% to 0.2% of the adult population . Prevalence increases with age, and the condition is a chronic recurring problem with people experiencing episodes of open leg ulceration lasting from a few weeks to 50 years . Given this pattern of ulceration, healing and recurrence, it has been estimated that up to 1% of the population will be affected by leg ulceration at some point. The majority of leg ulcers are caused by venous disease, other causes include arterial disease, vasculitis and diabetes.

    Pain is a frequently reported feature of venous leg ulceration . The precise prevalence of pain is difficult to determine due to methodological differences between the trials and the use of predominantly hospital populations. Reported figures for people experiencing severe or continuous pain associated with a leg ulcer range from 17% to 65% . It is accepted that when pain is a feature it has a major impact on both sufferers’ and carers’ quality of life, with sufferers stating that the worst aspect of having a leg ulcer is the pain .

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    Looking After Yourself During Treatment

    The following advice may help your ulcer heal more quickly.

    • Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
    • Whenever you’re sitting or lying down, keep your affected leg elevated.
    • Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
    • If you’re overweight, try to reduce your weight with a healthy diet and regular exercise.
    • Stop smoking and moderate your alcohol consumption. This can help the ulcer heal faster.
    • Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

    You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice.

    Venous Leg Ulcer Treatment

    Treating Venous Leg Ulcers

    A venous ulcer can be healed by either applying strong sustained compression with a bandage or a stocking, and by treating the underlying cause of the ulcer. When appropriate, both treatments can be used at the same time.

    Following the advice below may help your venous leg ulcer heal more quickly:

    • Try to keep active by walking regularly. Immobility can make venous leg ulcers and the associated symptoms, such as

    Graduated elastic medical compression stockings can be used by patients with reasonable strength in their hands, since they can be a little difficult to put on. Modern systems are available that contain two stockings both are worn on the ulcerated leg during the day and one is removed at night. These are easier to use than one heavy stocking.

    Ulcer dressings can be applied after removing both stockings. Many patients find they can manage this themselves.

    There are many different types of bandage used to treat venous leg ulcers. Some use just one type of bandage, while others are made up of several layers. The application of a compression bandage is a skilled procedure and should be done by a healthcare professional trained in leg ulcer management.

    Bandaging of the leg is usually done after a leg ulcer dressing change. The bandage and ulcer dressing can then remain in place for up to a week, depending on how often ulcer dressing changes are required.

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