Pain impacts health and decreases quality of life.

When pain interferes with daily activities and quality of

life, it's especially important. For example, if you don't want to do things because they cause pain, it's
time to see the doctor. Pain impacts your physical, social and emotional health. It can cause you to feel
depressed and anxious or cause sleep, family or work problems. If that's happening, it's certainly time to
see the doctor. Pain is a thief. It has the ability -- kind of like cancer -- to take away your relationships
and your ability to feel good. There is no reason to live with pain when we have the ability to control
pain. We need to bring it out of the shadows and into the light so that everyone feels comfortable
discussing pain and its impact with their health-care providers. We can control pain and we can improve
quality of life for people living with cancer. That's a huge and important improvement to enhance the
rest of an individual's life, no matter whether you expect to live days or many years.

Examples of side effects of over-the-counter

medicines
 Acetaminophen (Tylenol)

This medicine may cause:

oNausea.
o Rash.
o Liver damage (with high doses).
 Nonsteroidal anti-inflammatory drugs (such as Advil,
Aleve, and Motrin)

These may cause:

o Stomach upset, heartburn, and nausea. Taking the

medicine with food may help prevent these
problems.
o Stomach ulcers and kidney problems (with long-term
use).
o Allergic reaction (rare).
o Increased risk of heart attack and stroke. These risks
are greater if the medicine is taken at higher doses
or for longer than recommended.
Stasis Ulcer/Venous Ulcer
A stasis ulcer is a breakdown of the skin (ulcer) caused by fluid build-up in the skin from poor
vein function (venous insufficiency). Fluid leaks from the veins into skin tissue when the blood
backs up rather than returning to the heart through the veins.

Who's at risk?
Leg vein malfunction (venous insufficiency) affects 2–5% of Americans, and approximately half
a million Americans have stasis ulcers. Women are more often affected by stasis ulcers than
men.

Your risk for acquiring a stasis ulcer is greater if you:

 Are overweight.

 Have varicose veins.

 Have had blood clots in your legs.

 Had a leg injury (trauma) that might affect blood flow in your leg veins; even minor trauma may
cause an ulcer.

Signs and Symptoms

Swelling of the leg, brown discoloration, or an itchy, red, rough area (stasis dermatitis) may
appear before you notice an ulcer. This is often seen on the inner ankle area first, although any
area on the lower leg may be affected. Varicose veins may be present. Sometimes there are hard,
tender lumps under the skin near the ulcer.

The ulcer is a crater-like, irregular area of skin loss. It may be an open, easily bleeding, painful
wound, or it might have a thick black scab. The level of pain varies.

Self-Care Guidelines
People with a leg ulcer should seek medical care if it is anything beyond a small scrape or cut on
the surface of the skin.

If the ulcer appears minor:

 Clean it with soap and water.

 Apply a thin layer of petroleum jelly (Vaseline®) and a clean gauze bandage.

 Avoid putting any tape or adhesive on the skin.

 Avoid using topical antibiotics and other over-the-counter products, as people with leg ulcers
often become allergic to these products.

 Venous ulcers, or stasis ulcers, account for 80 percent of lower extremity ulcerations.1 Less
common etiologies for lower extremity ulcerations include arterial insufficiency; prolonged
pressure; diabetic neuropathy; and systemic illness such as rheumatoid arthritis, vasculitis,
osteomyelitis, and skin malignancy.2 The overall prevalence of venous ulcers in the United
States is approximately 1 percent.1 Venous ulcers are more common in women and older
persons.3–6The primary risk factors are older age, obesity, previous leg injuries, deep venous
thrombosis, and phlebitis.7

 Venous ulcers are often recurrent, and open ulcers can persist from weeks to many years.8–
10
Severe complications include cellulitis, osteomyelitis, and malignant change.3 Although the
overall prevalence is relatively low, the refractory nature of these ulcers increase the risk of
morbidity and mortality, and have a significant impact on patient quality of life

Compression therapy has been proven beneficial for venous ulcer treatment A 2, 7, 10, 22–
and is the standard of care. 26, 45

Leg elevation minimizes edema in patients with venous insufficiency and is C 27

recommended as adjunctive therapy for venous ulcers. The recommended
regimen is 30 minutes, three or four times per day.

Dressings are beneficial for venous ulcer healing, but no dressing has been A 28, 29
shown to be superior.

Pentoxifylline (Trental) is effective when used with compression therapy for A 31

venous ulcers, and may be useful as monotherapy.

Aspirin (300 mg per day) is effective when used with compression therapy
for venous ulcers.

Pathophysiology
The pathophysiology of venous ulcers is not entirely clear. Venous incompetence and associated
venous hypertension are thought to be the primary mechanisms for ulcer formation. Factors that
may lead to venous incompetence include immobility; ineffective pumping of the calf muscle; and
venous valve dysfunction from trauma, congenital absence, venous thrombosis, or
phlebitis.14Subsequently, chronic venous stasis causes pooling of blood in the venous circulatory
system triggering further capillary damage and activation of inflammatory process. Leukocyte
activation, endothelial damage, platelet aggregation, and intracellular edema contribute to venous
ulcer development and impaired wound healing