Aim: To explore the experience and management of pain associated with chronic leg
ulceration in older people. Two studies were designed, to address patient and
professional perspectives.
Study 1.
Method: A qualitative study using grounded theory methodology, which explored the
experience of pain from leg ulcers.
Results: Eleven patients aged 65 years and over described their pain as chronic,
producing negative consequences such as depression and insomnia, in part due to
inadequate pain management. A three phase theory was developed to illustrate
patients' leg ulcer journey. In phase 1, leg ulcer pain has predominantly acute
nociceptive properties. If this is not managed effectively, or ulcers do not heal, or they
recur, the patient may develop chronic pain with both nociceptive and neuropathic
properties (phase 2). If this pain is not managed effectively, patients may develop
refractory chronic neuropathic pain (phase 3).
Study 2.
Method: A feasibility study which surveyed the knowledge and views of a sample of
community nurses in the North of England. Data were collected using a postal
questionnaire.
Results: 115 (32%) completed questionnaires were returned. The majority of
respondents were female (n=102, 91.8%). Over one-third of the nurses had received
no pain management training. Approximately half reported not assessing pain
appropriately. A significant majority indicated they were using preconceived ideas
rather than patient pain report as a basis for pain management decisions.
Overall conclusion: The results suggested that older patients had painful leg
ulceration which produced negative consequences and they were not receiving
appropriate pain management. Nurses had limited understanding of the nature,
assessment and management of leg ulcer pain, particularly its neuropathic elements.
The emphasis on healing appeared to impede effective pain management. Only when·
healthcare professionals understand and acknowledge the nature of the pain in this
patient group, can the pain be managed effectively.