This study examined the prevalence and characteristics of wound pain in diabetes-related foot ulcers. It found that over 50% of patients reported experiencing wound pain based on formal pain assessment tools, even though some did not report pain to their podiatrist. Pain was described as tender, brief, or intermittent. Both neuropathic and neuroischaemic ulcers had low reported pain intensity and little effect on quality of life. The study concludes wound pain may be underassessed clinically and more research is needed to understand differences in pain between ulcer types.

1. Risk of
infection &
amputation
A. Dickinson1, N. Frescos2, J. Firth3 & Assoc Prof P. S. Hamblin3
1ISIS Primary Care, 2La Trobe University, 3Western Health Diabetes Foot Service
Melbourne, Australia
KEY OBJECTIVES
1. To determine the prevalence of wound pain in diabetes-related foot
ulcers.
2. To assess whether there is a difference in pain intensity and the
nature of pain between wound aetiologies of neuropathic,
neuroischaemic and ischaemic wounds.
Relationship issuesRelationship issues
Depression
Stress & anxiety
Fatigue
Activities of daily living
Delayed
wound
healing
Delayed
wound
healing
Wound pain
(Downe, 2012; Hogg, 2012; Woo & Sibbald, 2008; Winkley, 2009)
BACKGROUND
 Many health professionals believe foot ulcer pain does not exist in
people with peripheral neuropathy.
(Sibbald et al., 2003)
 Current research has found up to 86% of individuals with diabetic
foot ulcers experience wound specific pain.
(Ribu et al., 2006; Bengtsson, Jonsson & Apelqvist, 2008; Bradbury & Price, 2009).
 No studies have conducted valid statistical analyses to compare
the pain characteristics between neuropathic, ischaemic &
neuroischaemic foot ulcers. Determining the likely underlying
aetiology of pain alters pain management practices and has
implications to improve healing outcomes.
(Bowers & Barrett, 2009)
The characteristics of wound pain
associated with diabetes-related foot
ulcers: a pilot study

2. STUDY DESIGN:
 Conducted at a major teaching hospital in Melbourne, Australia.
 Recruitment occurred between March to May 2013.
 The questionnaire incorporated 2 formal pain assessment tools:
 McGill Pain Questionnaire (Short Form)
 Brief Pain Inventory (Short Form)
Method:
The characteristics of wound pain
associated with diabetes-related foot
ulcers: a pilot study

3. The characteristics of wound pain
associated with diabetes-related foot
ulcers: a pilot study
PARTICIPANT CHARACTERISTICS:
• 15 participants included in study:
 87% (n=13) male
 60% (n=9) had neuropathic ulcers.
 40% (n= 6) had neuroischaemic ulcers.
 No purely ischaemic ulcers were
observed .
 60% (n=9) reported analgesia usage
WOUND PAIN PREVALENCE:
• Formal assessment tools had a
higher reported pain prevalence
(53%) compared to a singular
question asked by the researcher
(33%).
• Post-interview no outpatients
reported pain to their podiatrist
(refer to Figure 1).
Key Findings:
80 patients screened for
eligibility
28 patients considered
eligible to participate in
study
15 consenting participants
interviewed & included in
study sample

4. The characteristics of wound pain
associated with diabetes-related foot
ulcers: a pilot study
Key Findings:
WOUND PAIN CHARACTERISTICS:
 Low scores for pain intensity and effect of pain on health-related quality of
life were reported for both aetiological groups (refer to Table 1).
 From the total sample:
 13% described their pain as 'brief'
 40% described their pain as 'intermittent'
 7% described their pain as 'continuous'
 40% described their pain as 'doesn't exist'
 The most frequently chosen pain quality to describe wound pain was the
term 'tender'.
Table 1. Wound pain intensity and the effect of pain on health-related quality of life scores.
Neuropathic
Ulcer Group (n =9)
Neuroischaemic
Ulcer Group (n=6)
Total Sample
(n=15)
Present pain intensity
(100mm VAS scale) 12.9 ± 19.9 (0-60mm) 0.5 ± 1.2 (0-3mm) 7.6 ± 16.0 (0-60mm)
Average pain intensity in the
past 24 hours (out of 10) 1.6 ± 2.1 (0-5.8) 0.6 ± 0.9 (0-2) 1.2±1.8 (0-5.8)
Mean effect of pain on health-
related quality of life in the past
24 hours
(out of 10)
1.8 ± 2.2 (0-6.4) 0.9 ± 2.1 (0-5.1) 1.5 ± 2.1 (0-6.4)

5. The characteristics of wound pain
associated with diabetes-related foot
ulcers: a pilot study
 Wound pain can be present in diabetes-
related neuropathic and neuroischaemic foot
ulcers, despite analgesia useage.
 Wound pain appears to not be accurately
assessed in clinical practice.
 Future research is required to establish
whether a statistically significant and clinically
important differences in wound characteristics
exist between diabetic foot ulcer types.
For more information please email:
Ashlea.Dickinson@isispc.com.au
Conclusion: