(151) Chronic leg ulcer pain – a need for effective topical analgesia

Abstract

Severe, persistent pain from chronic wounds is common and poorly treated. Chronic leg ulcers (venous, arterial, diabetic) affect 0.6-3% of people over 60 years old and for many the worst problem associated with the ulcer is pain, which is severe in more than 70% of cases. In addition, many wound care procedures such as debridement and dressing changes exacerbate pain. Current treatments with systemic analgesics, including opioids, frequently fail to provide adequate pain control and often result in intolerable adverse effects. Effective topical analgesia could offer an ideal solution for chronic wound pain management. However, in the US, there are no prescription-strength topical analgesics available for use on wounds. We performed a systematic literature review to identify clinical trials evaluating the efficacy of topical analgesics for leg ulcer pain. PUBMED, MEDLINE, and EBSCO databases were searched (to October 2015) and revealed 114 publications, of which 20 were eligible for inclusion in this review. Of these, only 8 were randomized, double-blind and placebo controlled. Five studies using ibuprofen impregnated foam dressing demonstrated some efficacy on painful leg ulcers (VAS decrease 5-22). Eight studies supported the use of topical lidocaine plus prilocaine (EMLA) cream for pain control during wound debridement (VAS decrease 27-65.5). However, the slow onset of action could limit its usefulness. While many other products, including opioids, have been formulated for topical use and evaluated in leg ulcer pain, their efficacy has not been consistently superior to control groups. Thus, in the US market, there is no topical product specifically approved for wound pain management, and leg ulcer pain continues to be poorly managed with systemic drugs and off label use of topical agents. Better topical analgesics, ideally ones with a rapid onset and prolonged action, are still an urgent clinical need for patients with chronic wounds.