Chronic Wound Pain – Suffering Unheard

Richard Chapman and Mandy Leighton-Bellichach say that patients with chronic wound pain are suffering worldwide

Mandy Leighton-Bellichach, President of the European Pain Network and Chairperson of the Society for Fighting pain, Israel says “Within the millions of Europeans suffering from chronic pain, there is a shockingly large group of people who have been overlooked for years: those suffering from chronic wound pain. This an unexpectedly common problem affecting not only the elderly and those immobilized but many others. All speak of the pain as the most debilitating part of living with chronic wounds. Despite being the main problem they have to deal with, this devastating pain has been neglected and overlooked.

“Clearly something must change. The time has come for the medical world to acknowledge the seriousness of this issue and the vast amount of people afflicted with chronic wound pain. As nurses are those who actually treat the wounds and are in constant contact with those suffering from chronic wound pain, there is a great need for further training for nurses dealing with this complex issue.

“Despite suffering in the past from chronic wound pain, I myself was not aware of the magnitude of this problem. As President of the European Pain Network, I have now taken the matter to heart. I will do my best to raise the level of awareness regarding chronic wound pain, together with my colleagues across Europe."

Richard Chapman, Director of the Pain Research Center, University of Utah, explains:

What is a chronic wound?

Most wounds heal, but those that do not heal within three months are defined as chronic wounds. The vast majority of chronic wounds consist of venous and arterial leg ulcers, pressure ulcers and diabetic foot ulcers. Leg ulcers and pressure ulcers are most common among elderly patients. Diabetic foot ulcers are very common among all patients suffering from diabetes. Chronic wounds differ in size and nature; some will heal within six months whilst others will never heal. There are patients who have wounds for 20-30 years. Overall, 35 % of the chronic wounds do not heal within 5 years.

The characteristics of chronic wound pain

Two kinds of pain exist in a chronic wound. First of all there is the pain due to tissue damage. This pain is called nociceptive pain and is the most common type of wound pain. The nociceptive pain is relieved by conventional analgesics like paracetamol, NSAIDs, local anesthetics and opioids and is often described as a burning or rubbing pain. The second kind of pain — neuropathic pain — is caused by nerve damage. It may occur following nociceptive pain and injuries. The neuropathic pain is characterized by a stabbing sensation and is often treated with antidepressants or antileptics.

Today, in the UK more than 380,000 people suffer from chronic leg ulcers. The pain from these wounds seriously affects quality of life. Approximately 63% of all patients with chronic wounds may at some point suffer depression due to the ulcer.

Nearly 2% of us, a million people in the UK, will suffer from a chronic wound in our lifetime. Yet, chronic wounds are probably one the most neglected health problems. Pain is by far the worst aspect of having a leg ulcer. But it is a neglected disease; there is a severe lack of resources, attention and adequate means for the treatment of chronic wounds and chronic wound pain. Consequently, patients do not get the best treatment: Why does this happen? Why are these patients suffering in silence?

The elderly suffer in silence

The majority of people suffering from chronic wound pain are elderly, and they are less likely to complain. The elderly accept pain, and see relief as being almost impossible. Chronic wound patients are primarily treated in the community and are not transferred to pain clinics.

A call for action

For our part, we are planning to undertake research into chronic wound pain at the Pain Research Center in Utah and this year EFIC – the European arm of IASP (The International Association for the Study of Pain) – is focusing on “Pain in the Elderly”. During this initiative, we will try to create awareness within the pain community of the problem of chronic wound pain. Special thanks must go to the organization Pain Concern, which has helped us publicize this issue.

Professor Richard Chapman is Director of the Pain Research Center, University of Utah, Salt Lake City, USA and former President of the American Pain Society.

Mandy Leighton-Bellichach is President of the European Pain Network and Chairperson of the Society for Fighting Pain, Israel.

For information:
www.efic.org and www.europeanpainnetwork.org

Acknowledgement: Pain Concern acknowledges assistance from Sigma in compiling this information. Pain Concern receives no financial support from Sigma and does not endorse any of their products.