Chronic Pain Treatment for Patients with Vascular Ulcers of the Lower Limbs

Abstract

Pain is found in 46-84.5% of patients with vascular ulcers of the lower limbs, varying according to the records considered and the etiology of the ulcer. Vascular ulcers associated with arterial insufficiency are generally more painful than vascular ulcers associated with venous insufficiency. An algorithm for the management of chronic cancer pain in patients is provided by the WHO analgesic ladder, which is commonly used by physicians. In clinical practice, the ladder is also applied to chronic non-cancer pain, even though this kind of application is limited by the absence of an evaluation of the pathogenetic mechanisms of pain. The WHO analgesic ladder drives therapy solely depending on the severity and persistence of pain, recommending progressive "step by step" pharmacologic therapy, starting with non-opioid medications (NSAIDs and Paracetamol) for mild pain, followed by mild (e.g. tramadol) and strong opioids (e.g. morphine) for moderate to severe pain. It must be noted that addiction to long-term therapy may occur even with non-opioid drugs. Short-term therapy with opioids has been associated with adverse reactions (nausea, constipation, sleepiness, dizziness and itching) in nearly 50% of the patients. Our revision of the literature on this subject analyzes the issues of analgesic chronic therapy with opioids, providing directions on how to optimize it for patients with chronic pain associated with the presence of vascular ulcers of the legs.