Chronic wounds remain common, according to two studies presented during the European Wound Management Association’s (EWMA) recent meeting in London.

In the first study, researchers from Dublin reported that during a week in November 2013, 3.7 per cent (n=445) of an urban population had at least one wound. Surgical wounds were the commonest (42.7 per cent), followed by leg ulcers (18.9 per cent), pressure ulcers (10.3 per cent) and diabetic foot ulcers (5.2 per cent).

Two-thirds (67.6 per cent) of patients had one wound but one patient had eleven wounds. Almost one in 12 (8.5 per cent) chronic wounds persisted for more than five years. The second study, from Birmingham and Solihull Mental Health NHS Foundation, enrolled 452 patients with chronic wounds. Of these, 2.9 per cent had multiple wounds.

Leg ulcers were commonest, accounting for 26 per cent, while a similar number of chronic wounds persisted for at least 12 months.

…but wound pain is often overlooked

Healthcare professionals may “overlook and discount” pain associated with chronic wounds, the Journal of Clinical Nursing reports. Patient anxiety was also found to strongly mediate the relationship between anticipated and experienced pain. The study enrolled 96 patients aged between 60 and 85 years with chronic wounds.

Venous leg ulcers accounted for 85.4 per cent of the wounds followed by pressure ulcers (11.5 per cent) and foot ulcers (3.1 per cent). The median score for anticipatory pain was 5 on a scale of 0-10. The median pain score was 3 before a dressing change rising to five during dressing removal and cleansing.

Median pain scores declined to 2.5 at dressing application. The median anxiety score was eight on a scale of 5-20. People who anticipated more pain also reported greater anxiety and more severe pain when their dressing was changed.

Wound duration correlated inversely with pain. Patients with wounds with heavy exudate and covered with necrotic tissue experienced more anxiety that those with wounds with light exudate, covered with granulation tissue. Wounds with heavy exudate and necrotic tissue can leak and be malodourous, which may contribute to anxiety.

Eleven patients routinely received analgesics, which suggests that wound-related pain “is often underestimated and untreated”. (doi: 10.1111/ jocn.12858)