Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Thursday, February 2, 2017

Peripheral Artery Disease

Peripheral artery disease (PAD) is a common and disabling health condition affecting 20% of people over age 75. This disease is primarily caused by atherosclerotic changes in the arteries limiting normal blood flow to the lower extremities. As the disease progresses, insufficient oxygen and nutrients to the tissue can result in complications such as chronic leg pain, skin ulceration, gangrene, and eventually amputation. One of the most common and earliest manifestations of PAD is intermittent claudication; described as pain in a lower extremity muscle group (such as the buttock, thigh, and calf) that is elicited by exertion and relieved within a few minutes of rest.  Over time, pain may be elicited by minor exertion and become more frequent even at rest. There is evidence that two-thirds of people with mixed venous arterial leg ulcers experience moderate to severe pain daily.  As such, people with PAD are more likely to experience a loss of autonomy, disability, work impairment, emotional distress, and poor quality of life compared with individuals without PAD.

Ischemic pain is complex and caused by a multitude of mechanisms, including the lack of oxygen, accumulation of metabolic waste, reperfusion injuries, inflammation, nerve damage, vasospasm, trauma, and anxiety.  However, ischemic PAD is underrecognized, underdiagnosed, and therefore, undertreated.  Routine use of opiates could cause many adverse effects (such as drowsiness and confusion), but do not always provide adequate pain relieve. Although we recognize a need for a holistic approach to address ischemic pain, none of the existing guidelines addresses best practice for ischemic pain. This is an area that will benefit from interprofessional collaboration involving specialists in pain management, psychology, rehabilitation science, vascular medicine, and palliative care.