Painful leg ulceration: a prospective, longitudinal cohort study

Objective To explore the relationship between pain mechanism, pain intensity and leg ulcer characteristics. Design A six month longitudinal cohort study in a community setting in the north of England. Participants 95 patients with leg ulceration referred consecutively to district nurses. Main outcome measures Pain intensity using daily visual analogue scores, leg ulcer characteristics (aetiology, size, location, duration) and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Results Type, duration, position and size of the leg ulcer had no effect on average daily pain scores. Using the LANSS questionnaire, 43.5% of respondents reported symptoms suggestive of a neuropathic mechanism to their pain. Patients with neuropathic symptoms had higher average daily pain scores (p<0.001). Fewer people healed with neuropathic symptoms compared to those with no neuropathic symptoms (30.8% versus 52.1%). Conclusion Severity of pain can not be predicted by the type, size, position or duration of ulceration. Patients who scored positively for neuropathic symptoms had higher average daily pain scores and fewer had healed leg ulcers at 6 months compared to those who did not experience neuropathic sign and symptoms. This is an interesting future avenue for research.