Can venous and arterial leg ulcers be differentiated by the characteristics of the pain they produce?

Aim. To explore the characteristics of venous and arterial leg ulcer pain among people cared for in the community. Background. There is little information available concerning the different characteristics of pain resulting from venous and arterial leg ulcers. The identification of clear differences in pain experience might aid recognition of arterial deterioration and provide a useful adjunct for existing diagnostic procedures. Design. This was a prospective interview-based survey. Method. Structured interviews were conducted with each of the participants in their home. Ulcer history, pain (McGill pain questionnaire and verbal rating scale) and factors influencing pain were assessed. Results. Fifty-two women and 27 men aged 77.7 (SD 8.9) took part. Pain scores for least, average, worst and present pain varied widely, and arterial ulcers were associated with the highest average pain scores. Pain tended to be worst at night and least in the afternoon; arterial ulcers were more painful than venous ulcers on lying down. Venous leg ulcers were frequently described as throbbing, burning and itchy, while arterial ulcer pain tended to be described as sharp and hurting. Conclusions. Some characteristics of pain appeared to be suggestive of the leg ulcer type. Differences were found in the words chosen to describe the pain as well as the temporal and postural aspects of arterial and venous leg ulcer pain. More research is needed to confirm these preliminary findings. Relevance to clinical practice. Patients' descriptions of pain have the potential to supplement other methods of differentiating between types of leg ulcer and provide an early-warning indicator for transition from venous to arterial ulceration.