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Leg ulcer - venous - Management
How do I manage pain associated with a venous leg ulcer?

  • Determine the duration, nature, and severity of the pain to exclude an additional cause. Worsening pain may indicate poor ulcer healing, arterial disease, diabetic neuropathy, or cellulitis.
  • Advise the person that leg elevation will help with the pain associated with oedema.
  • Prescribe paracetamol or a combination of paracetamol and codeine phosphate according to the severity of pain and the person's response to treatment. Do not routinely prescribe nonsteroidal anti-inflammatory drugs.
Clarification / Additional information
  • Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Severe or worsening pain may indicate a complication:
    • Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting oedema, collagen (lipodermatosclerosis), or infection.
    • Intermittent pain can be related to dressing changes or debridement procedures.
Basis for recommendation
  • These recommendations are based on clinical guidelines: The nursing management of patients with venous leg ulcers published by the Royal College of Nursing [RCN, 2006], Management of chronic venous leg ulcers published by the Scottish Intercollegiate Guidelines Network (SIGN) [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
  • Between 17% and 65% of people with a leg ulcer experience severe or continuous pain with a major impact on quality of life [Briggs and Nelson, 2003]. Pain relief is important to maximize quality of life, enable mobilization, and improve appetite.
  • CKS does not recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control because they impair wound healing and may worsen leg oedema. NSAIDs affect the inflammatory phase by inhibiting cyclo-oxygenase production, which reduces the tensile strength of the wound [Enoch et al, 2006].
  • There is less evidence for the use of topical analgesic treatments in venous ulcer management [Briggs and Nelson, 2003].

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