Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of venous ulcer disease

BMJ 2010; 341 doi: (Published 12 November 2010) Cite this as: BMJ 2010;341:c6045

Rapid Response:

Painful venous ulcers

Venous leg ulceration is a chronic condition with consequences to the
individual that reach beyond the breached squamous epithelium. Patients
with venous ulceration may experience significant pain, depression, sleep
disturbance and disability (1). The review by Wijnand Bert van Gent and
colleagues evinces a description of the pathology and medical treatment of
venous ulcers but it is surprising coy about the effect on the patients
wellbeing and what to do about it.

Pain is a significant problem in a large minority of patients with
venous ulcers (2). Dressing changes can be especially painful and a number
of strategies have been tried to prevent this. Some patients experience
continuous severe pain in between dressing changes which makes life very
difficult for them and their carers. Doctors in the 21st century
understand that the management of chronic conditions isn't just about the
pathology and biology of disease it is also about the managing pain,
disability and suffering which Wijnand Bert van Gent and colleagues seem
to have chosen to ignore.

1. Hamer C. Patients' perceptions of chronic leg ulcers. J Wound Care
1994; 3: 99-101
2. Noonan L, Burge SM. Venous leg ulcers: is pain a problem? Phlebology
1998; 3: 14-9

Competing interests: No competing interests

24 November 2010
Ivan L Marples
Consultant in Pain Medicine
Lothian Health Board