Quality of Life with a Chronic Wound

An open wound may be embarrassing and can be concerning to a patient for many other reasons. An open wound may be painful, drain fluids, have a bad odor, and require many resources to treat. In addition, a wound may represent an increased risk for infection, amputation, admission to the hospital, and sometimes death. Having an open wound for a prolonged duration can negatively affect the feeling of self-worth and personal and professional relationships.^[1] The term “chronic wound” is an umbrella term, used to describe a wound that does not heal normally. Some examples include pressure ulcers, venous leg ulcers, diabetic foot ulcers, surgical wounds, infectious wounds, radiation poisoning wounds, and ischemic wounds where the wound does not get enough blood supply.^[2,3] Chronic wounds can affect up to 5.7 million patients in the United States; venous leg ulcers can be present in up to 1% of the elderly population and the risk doubles in the elderly.^[2,4-6]

Normal Steps for a Properly Healing Wound

Wound healing is a complex process but wounds typically heal in four overall stages: a hemostasis phase (when bleeding is stopped), an inflammatory stage, a growth stage, and a remodeling stage.^[5] A misstep in any of these steps can lead to a chronic wound; for example, patients suffering from pressure ulcers often cannot move past the inflammatory stage.^[7]

Biological Effects of a Chronic Wound

Pain is likely a significant problem associated with chronic wounds, and a decreased ability to move around is often correlated with the wound as well.^[8] Sometimes the pain of a chronic ulcer can be so terrible that patients with pain that cannot be improved with painkillers have considered amputations for their chronic leg wounds.^[9,10]

It is important to know that pain in any wound may be the first sign of infection, and therefore a healthcare professional should be consulted as soon as possible. Other strategies to relieve the pain associated with a chronic wound will depend on the cause of the wound and always begin by addressing the underlying problem (for example: reducing the swelling associated with a venous leg ulcer). Depending on the cause of the wound, some coping strategies to help relieve the pain caused by ulcers may include movement (e.g. walking around), rest, doing distracting activities to avoid thinking about the ulcer, avoiding pain triggers, alternating positions of the limb such as elevation or lowering of the limb, and wearing compression stockings to help reduce swelling.^[9,11-13] Several medications exist to help with the pain, and a healthcare professional can assist to match the right medication to the type of wound and type of pain.

Psychological Effects of Chronic Wounds

Patients suffering from a chronic wound can have negative effects on their social and emotional wellness.^[14] While pain is the most consistent symptom of a chronic wound, feeling frustrated and resentful about a chronic wound is common.^[8,15-18] In interviews with patients suffering from chronic wounds, 58% of the patients stated the ulcer was a burden to their life; and the study showed that the time spent caring for an ulcer was correlated to feelings of anger and resentment.^[8] The pain caused by chronic wounds can disturb sleep, preventing proper rest, and impair one’s sense of well-being during the day.^[18-20] Not getting enough sleep can contribute to anxiety about the wound.^[17] Patients can feel as if they have lost control and lose trust in their healthcare providers.^[17] In a Brazilian study of patients with venous leg ulcers, approximately 30% of the patients noted anxiety and 40% noted depression about their chronic wound.^[21]

Chronic wounds can affect patients on both a financial level as well as an emotional level. In patients studied in Australia, participants with chronic wounds spent approximately 10% of their income on wound bandages and alike products.^[22] Additionally, for the participants in the Australian study younger aged patients reported a lower quality of life than their older counterparts. Elderly patients suffering from chronic wounds have described feeling inside a “prison” of their own body and hope for “freedom” in a healed body, free from the burden of the chronic wound.^[23] While physical activity is recommended to help improve chronic wounds, many patients avoid physical activity or movement due to fear that the activity will cause injury or worsen the pain.^[9,18,23] This fear of movement can lead to avoidance behavior, and incorrectly interpreting the pain as a threat can further the limited use and depression with chronic wounds.^[24] 

When healthcare providers better understand the patient’s personal and financial concerns, they can better aid their patients in developing an appropriate treatment plan that best suits the patient’s needs.^[25] In a study examining patient and physician perceptions of chronic wound pain, often the physicians underestimated the pain as they did not perceive the wounds as life-threatening.^[8] It is important to understand the underlying cause of a chronic wound, as this may also help a care provider to create a better treatment plan.^[26]