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. 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. 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.
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. 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. 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. 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. Patients can feel as if they have lost control and lose trust in their healthcare providers. 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.
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. 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. 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.
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. 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. 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.
- Kapp S, MiIller C, Santamaria N. The quality of life of people who have chronic wounds and who self-treat. J Clin Nurs.2017;10.1111/jocn.13870PMID: 28493644 Link to research.
- Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle).2015;4(9):560-582; PMID: 26339534 Link to research.
- Chronic Wounds. 2017; Link to research.
- Branski LK, Gauglitz GG, Herndon DN, et al. A review of gene and stem cell therapy in cutaneous wound healing. Burns.2009;35(2):171-180; PMID: 18603379 https://www.ncbi.nlm.nih.gov/pubmed/18603379.
- I de la Torre J. Chronic Wounds: Overview, The Biology of Wound Healing, Common Chronic Wounds. 2015; Link to research, 2017.
- Callam M. Prevalence of chronic leg ulceration and severe chronic venous disease in western countries. Phlebology.1992;7:6-12; PMID:
- Management of chronic pressure ulcers: an evidence-based analysis. Ont Health Technol Assess Ser.2009;9(3):1-203; PMID: 23074533 Link to research.
- Phillips T, Stanton B, Provan A, et al. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Am Acad Dermatol.1994;31(1):49-53; PMID: 8021371 Link to research.
- Hyland ME, Lay A, Thomson B. Quality of life of leg ulcer patients: questionnaire and preliminary findings. Journal of Wound Care.1994;3PMID: Link to research.
- Bland M. Coping with leg ulcers. Kai Tiaki: Nursing New Zealand.1996;2PMID: Link to research.
- Hareendran A, Bradbury A, Budd J, et al. Measuring the impact of venous leg ulcers on quality of life. Journal of Wound Care.2005;14PMID: Link to research.
- Ebbeskog BE, S L. Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment. Scandinavian Journal of Caring Science.2001;15PMID: Link to research.
- Krasner D. Painful venous ulcers: themes and stories about living with the pain and suffering. J Wound Ostomy Continence Nurs.1998;25PMID: Link to research.
- Meaume S, Dompmartin A, Lok C, et al. Quality of life in patients with leg ulcers: results from CHALLENGE, a double-blind randomised controlled trial. J Wound Care.2017;26(7):368-379; PMID: 28704156 Link to research.
- Hamer C, Cullum N, Roe BH. Patients' perceptions of chronic leg ulcers. Journal of Wound Care.1994;3PMID:
- Cullum NRB. Leg ulcers: Nursing Management – A Research-based Guide. Scutari Press1995.
- Charles H. The impact of leg ulcers on patients' quality of life. Professional Nurse.1995;10PMID: Link to research.
- Walshe C. Living with a venous leg ulcer: a descriptive study of patients' experiences. Journal of Advanced Nursing.1995;22PMID: Link to research.
- Hyde CWB, Horsfall J, Winder G. Older women's experience of living with chronic leg ulceration. International Journal of Nursing Practice.1999;5PMID: Link to research.
- Douglas V. Living with a chronic leg ulcer: an insight into patients' experiences and feelings. Journal of Wound Care.2001;10PMID: Link to research.
- Souza Nogueira G, Rodrigues Zanin C, Miyazaki MC, et al. Venous leg ulcers and emotional consequences. Int J Low Extrem Wounds.2009;8(4):194-196; PMID: 19934181 Link to research.
- Kapp S, Santamaria N. The financial and quality-of-life cost to patients living with a chronic wound in the community. Int Wound J.2017;10.1111/iwj.12767PMID: 28635188 Link to research.
- Ebbeskog B, Ekman SL. Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment. Scand J Caring Sci.2001;15(3):235-243; PMID: 11564231 Link to research.
- Roaldsen KS, Elfving B, Stanghelle JK, et al. Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcer. Physiother Res Int.2009;14(3):167-180; PMID: 19194958 Link to research.
- Price P, Harding K. Cardiff Wound Impact Schedule: the development of a condition-specific questionnaire to assess health-related quality of life in patients with chronic wounds of the lower limb. Int Wound J.2004;1(1):10-17; PMID: 16722893 Link to research.
- Cullum N, Buckley H, Dumville J, et al. Wounds research for patient benefit: a 5-year programme of research. Programme Grants for Applied Research;10.3310/pgfar04130. Southampton (UK): NIHR Journals Library; 2016.