Alleviating Venous Ulcer Pain
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Pain is one of the most dreaded and least understood complications of chronic and acute wounds. Through the years research has confirmed that that moisture-retentive topical primary wound dressings can alleviate pain compared to gauze dressings in chronic venous1 or pressure2 ulcers and in acute burns3 surgical excisions4 or traumatic wounds.5 A recent Cochrane review concluded that a topical eutectic mixture (at lowest possible temperature of solidification) of 2.5% each of the two local anesthetics lidocaine and prilocaine (LP cream) reduced pain during venous ulcer debridement.6 The World Health Organization (WHO)7 has proposed a three-step ladder of systemic pain relief for cancer patients recommending oral non-opioids, such as aspirin and paracetamol, to address basic pain plus additional “adjuvants” to manage anxiety if needed. As pain increases to mild or moderate levels, the second step on the pain ladder adds a mild opioid such as codeine. The third step calls for a stronger opioid such as morphine as pain becomes moderate or severe. The right drug or combination is given every 3–6 hours to maintain freedom from cancer pain. How would the WHO pain ladder work for venous ulcer patients? Would chronic morphine use delay healing?8 Two studies summarized below suggest a different set of analgesic principles to achieve safe and effective venous ulcer pain relief.
Topical Cream or Inhaled Nitrous Oxide for Debridement Pain
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