Topical agents or dressings for pain in venous leg ulcers

M Briggs, EA Nelson

Research output: Contribution to journalArticle

Abstract

Background:
Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.

Objectives:
To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.

Search methods:
Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.

Selection criteria:
All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.

Data collection and analysis:
Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.

Main results:
No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5% cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95% Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.

Authors' conclusions:
EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.
Original languageEnglish
Article numberCD001177
Pages (from-to)1-29
Number of pages31
Journal Cochrane Database of Systematic Reviews
Issue number1
DOIs
Publication statusPublished - Jan 2003

Fingerprint

Varicose Ulcer
Leg Ulcer
Bandages
Pain
Debridement
Ulcer
Local Anesthetics
Analgesia
Wounds and Injuries
Complementary Therapies
Palliative Care
Research
Patient Selection
Meta-Analysis

Keywords

  • bandages
  • debridement
  • administration, topical
  • analgesics
  • anesthetics, local
  • ibuprofen
  • leg ulcer
  • lidocaine
  • ointments
  • pain
  • prilocaine
  • randomized controlled trial as topic
  • varicose ulcer

Cite this

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title = "Topical agents or dressings for pain in venous leg ulcers",
abstract = "Background:Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.Objectives:To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.Search methods:Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.Selection criteria:All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.Data collection and analysis:Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.Main results:No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5{\%} cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95{\%} Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.Authors' conclusions:EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.",
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author = "M Briggs and EA Nelson",
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doi = "10.1002/14651858.CD001177",
language = "English",
pages = "1--29",
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Topical agents or dressings for pain in venous leg ulcers. / Briggs, M; Nelson, EA.

In: Cochrane Database of Systematic Reviews , No. 1, CD001177, 01.2003, p. 1-29.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Topical agents or dressings for pain in venous leg ulcers

AU - Briggs, M

AU - Nelson, EA

PY - 2003/1

Y1 - 2003/1

N2 - Background:Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.Objectives:To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.Search methods:Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.Selection criteria:All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.Data collection and analysis:Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.Main results:No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5% cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95% Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.Authors' conclusions:EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.

AB - Background:Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.Objectives:To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.Search methods:Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.Selection criteria:All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.Data collection and analysis:Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.Main results:No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5% cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95% Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.Authors' conclusions:EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.

KW - bandages

KW - debridement

KW - administration, topical

KW - analgesics

KW - anesthetics, local

KW - ibuprofen

KW - leg ulcer

KW - lidocaine

KW - ointments

KW - pain

KW - prilocaine

KW - randomized controlled trial as topic

KW - varicose ulcer

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DO - 10.1002/14651858.CD001177

M3 - Article

SP - 1

EP - 29

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 1

M1 - CD001177

ER -