Understanding Pain and Quality of Life for Patients With Chronic Venous Ulcers
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Abstract: Aim. To identify the impact of pain on quality of life (QOL) of patients with chronic venous ulcers. Methods. A cross-sectional study was performed on 40 outpatients with chronic venous ulcers who were recruited at one outpatient care center in São Paulo, Brazil. WHOQOL-Bref was used to assess QOL, the McGill Pain Questionnaire-Short Form (MPQ) to identify pain characteristics, and an 11-point numerical pain rating scale to measure pain intensity. Kruskall-Wallis or ANOVA test, with post-hoc correction (Tukey test) was applied to compare groups. Multiple linear regression models were used. Results. The mean age of the patients was 67 ± 11 years (range, 39–95 years), and 26 (65%) were women. The prevalence of pain was 90%, with worst pain mean intensity of 6.2 ± 3.5. Severe pain was the most prevalent (21 patients, 52.5%). Pain most frequently reported was sensory-discriminative and evaluative in quality. Pain was significantly and negatively correlated with physical (PY), environmental (EV), and overall QOL. Compared to a no-pain group, those with pain had lower overall QOL. On multiple analyses, pain remained as a predictor of overall QOL (b = -0.73, P = 0.03) and was also predictive of social QOL, whereas pain did not have any impact on physical, emotional, or social relationships QOL (b = -3.85, P = 0.00) when adjusted for age, number, duration and frequency of wounds, pain dimension (MPQ), partnership, and economic status. Conclusion. To improve QOL of outpatients with chronic venous ulcers, the qualities and the intensity of pain must be considered differently.
Address correspondence to:
Vera Lúcia Santos, PhD
School of Nursing, University of São Paulo
Av. Dr. Enéas de Carvalho Aguiar
São Paulo 05403-000
Brazil
Phone: 55 1130 667 566
E-mail: veras@usp.br
Leg ulcers are significantly prevalent in the general population (0.6 to 3.6/1000 people) and among patients with chronic wounds.1 In Brazil, 55.1% of patients with chronic wounds presented venous ulcers (VU). 2 The majority of these patients has or will have pain at some point. Some studies described that the prevalence of pain among these patients was about 48% to 90%,3,4 and has been associated with impaired quality of life. 5–7
Pain in individuals with venous ulcers, like in any other individual, is usually multidimensional and has multiple causes. It results not only from the injury itself and its treatment, but also from a set of factors. These factors include culture, beliefs, attitudes, individual values, secondary gains, and others. 8 In the 1960s, Melzack et al9 proposed that pain was not just a sensorial experience. He proposed that pain composed at least 3 dimensions: sensorial-discriminative, affective-motivational, and cognitive-evaluative, characterizing pain as a multidimensional experience.
Pain can cause social, familial, and personal losses, and can impact negatively on diverse domains of quality of life (QOL). Quality of life, like pain, is a multidimensional concept defined by the World Health Organization10 (WHO) as the individual perception of his or her position in life within the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. Although the impact of a wound on daily life can be viewed from different perspectives, only an individual with a wound can genuinely understand the meaning of such an experience. 11
Quality of life for people with leg ulceration has been researched in some qualitative and quantitative studies. However, only some have investigated the relationship between QOL and pain.
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