Pharmacological Pain Management in Adults with Venous Ulceration: A Systematic Review

Layla Bolton Saghdaoui,1 Smaragda Lampridou,1 Layla Baldo,1 Sarah Onida,1 David Hohenschurz-Schmidt,2 Gillian M Chumbley,3 Leanne Atkin4 1Section of Vascular Surgery - Department of Surgery and Cancer, Imperial College London / Imperial College Healthcare NHS Trust, London, UK; 2Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; 3Pain Service, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK; 4School of Human and Health Sciences, University of Huddersfield and Mid Yorkshire NHS Teaching Trust, Huddersfield, West Yorkshire, UKCorrespondence: Layla Bolton Saghdaoui, Email [email protected]: Venous ulceration (VU) is a chronic lower limb wound caused by sustained venous hypertension. Treatment includes compression therapy, wound care and surgical intervention. Due to the prolonged nature of wound healing, patients experience a substantial burden on quality of life, largely influenced by pain. Existing literature generalises findings across all chronic wounds and there are no published reviews or specific guidelines informing pharmacological pain management for patients with VU.Methods: Five databases were searched to identify studies evaluating the effectiveness of pharmacological interventions for VU pain, published in English between 2000 and 2024. The CASP appraisal tools were used to assess the quality of publications, and findings are reporting descriptively and following PRISMA guidance.Results: Initial literature searches yielded 1,161 references, of which 447 were duplicates. Once screening was complete, thirteen studies were included in this evaluation. The majority (10/13) were randomised controlled trials comparing pharmacological interventions with standard care. Small sample sizes and poor reporting quality were common across all papers, and overall limits the evidence. Eight studies evaluated ibuprofen-impregnated dressings, all reporting some degree of pain reduction. Three studies investigated localized oxygen therapy, demonstrating improved wound healing outcomes. However, pain reduction was not statistically significant and may be secondary to healing. The remaining two studies examined topical sevoflurane and aspirin. Sevoflurane showed pain reduction over time in a single, low-quality retrospective study. The aspirin trial was inconclusive due to poor recruitment and underpowering.Conclusion: Currently, there is a lack of high-quality studies, evaluating the pharmacological treatment of pain in people experiencing VU. While there may be some evidence to support the use of topical agents such as ibuprofen, further industry-independent efficacy studies and cost analyses are required. Further research is also required to compare standard of care to commonly used agents such as oral paracetamol.Keywords: venous ulceration, pain, pain management, pharmacological pain management