Dalva Cezar da Silva Federal universidade of papai noel Maria, department of Nursing, santa Maria, RS, Brazil.

Você está assistindo: Como acabar com dores nas pernas


Correspondence to: Dalva Cezar da Silva correção Universitário, s/nº, BR 101 – Lagoa novo 59078-970 Natal, RN, Brasil. E-mail: dalvacezarsilva
mary de Lourdes Denardin Budó Federal university of papai noel Maria, room of Nursing, santa Maria, RS, Brazil. Maria Denise Schimith Federal university of papai noel Maria, department of Nursing, papai noel Maria, RS, Brazil. Marina de Góes Salvetti University of elas Paulo, college of Nursing, elas Paulo, SP, Brazil. Gilson de Vasconcelos torre Federal universidade of Rio compridas do Norte, Scholarship in research Productivity PQ2/ CNPq, Natal, RN, Brazil.About a authors
ABSTRACT

BACKGROUND and OBJECTIVES:

Pain is a common symptom in venous ulcer patients and should be controlled. Knowing a strategies supplied by patients e offering novo pain ao controle possibilities may be effective way to enhance assistance. This pesquisar aimed at identifying personal pain relief strategies supplied by venous ulcer patients.

METHODS:

This is a qualitative pesquisar including 14 venous ulcer patients treated in a angiology ambulatory of naquela teaching hospitais in the centro region that Rio compridas do Sul. Data were gathered in ns months of January and February 2013 by way of semi-structured interviews and data were evaluated by content analysis.

RESULTS:

Strategies provided by participants were: self-treatment, search for health service e religious support porque o pain relief. Reports imply that patients have not got guidance com regard come venous ulcers pains management and tried to reach pain relief through their very own methods.

CONCLUSION:

Participants the the pesquisar have reported utilizing simple, yet limited, strategies para pain relief, indicating der gap in the assistente offered to such patients.

Keywords:Chronic pain; Nursing; Venous ulcer


RESUMO

JUSTIFICATIVA E OBJETIVOS:

A dor é um sintoma freqüentemente em pacientes alcançar úlceras venosas, e ele deve ser controlada. Sabendo as estratégias utilizadas pelos paciente e oferecer novo possibilidades de direção da dor podem ser meios eficazes de melhorar a assistência. Ministérios objetivo isto estudo obtivermos identificar as estratégias pessoais de relevo da dor utilizadas pela pacientes alcançar úlcera venosa.

MÉTODOS:

Pesquisa qualitativa, que consiste em 14 pessoas abranger úlcera venosa acompanhadas no ambulatório de angiologia de um hospital universitário, da região centrais do Rio compridas do Sul. A coleta de dados adquirindo realizada nos meses de janeiro e fevereiro de 2013. Utilizou-se a entrevista semiestruturada e os dados foram avaliados pela meio da analisado de conteúdo.

RESULTADOS:

As estratégias usadas pelos participante foram: autotratamento, busca vir serviço de saúde e busca religiosa para emprego alívio da dor. Os relatos sugerem o que os pacientes que receberam orientações relacionadas ao manejo da qualificado em úlceras venosas e buscaram atender alívio da agonizante por seus privado meios.

CONCLUSÃO:

Os participantes do estudo relataram usar estratégias simples, mas limitadas, ao alívio da dor, indicando uma lacuna na assistência oferecida der esses pacientes.

Descritores:Dor crônica; Enfermagem; Úlcera venosa


introduction

Venous ulcer (VU) is a chronic wound affecting 1to 3% of ns world population, including energetic or healed ulcers11 Nettel F, Rodríguez Ramírez N, Nigro J, González M, conde A, Muñoa JA, et al. Primer unir latinoamericano de úlceras venosas. Rev Mex Angiol. 2013;41(3):95-126.. In Brazil, dia on the prevalence the VU are scarce, however there are studies on ns socio-demographic e clinical characterization of affected population in different country regions, indicating that this kind of injury affects ns adult population com higher incidence among a elderly and people com low socio-economic conditions22 Silva FA, Moreira TM. Propriedades sociodemográficas e clínicas de clientes alcançar úlcera venosa de perna. Rev Enferm UERJ. 2011;19(3):468-72.3 Angélico RC, Oliveira AK, Silva DD, Vasconcelos QL, de praia IK, torre GV. Socio-demographic profile, clinical e health that people com venous ulcers treated at der university hospital. Rev Enferm UFPE online. 2012;6(1):62-8.4 Oliveira BG, Nogueira GA, Carvalho MR, Abreu AM. Caracterização dos pacientes com úlcera venosa acompanhados no decorrer Ambulatório de Reparo de Feridas. Rev Eletrônica Enferm. 2012;14(1):156-63.-55 Sant"Ana SM, Bachion MM, santos QR, Nunes CA, Malaquias SG, Oliveira BG. . Rev Bras Enferm. 2012;65(4):637-44. Portuguese.. Comparative studies examining VU patient in Brazil e in portugal have shown much better quality of vida (QL) in the pain domain amongst patients viewed in health and wellness services of Evora, Portugal66 Torres GV, Balduino LS, beach IK, Mendes FR, Vasconcelos QL. Comparação dos domínios da qualidades de destino de clientes alcançar úlcera venosa. Rev Enferm UERJ. 2014;22(1):57-64.,77 Dias TY, beach IK, Liberato SM, Souza AJ, Mendes FR, torres GV. Qualidade de vida de pessoas com úlcera venosa: estudo comparativo Brasil/Portugal. Online Braz J Nurs. 2013;12(2):491-500..

Lower limbs VU negatively affects QL the people living with this injury88 Green J, Jester R. Health-related top quality of life e chronic venous leg ulceration: part 1. Br J community Nurs 2009;14(12):S12-7.,99 Hopman WM, Buchanan M, VanDenKerkhof EG, Harrison MB. Pain and health-related quality of vida in people com chronic foot ulcers. Chronic Dis Inj Can. 2013;33(3):167-74.. Pain is regular in VU patients e significantly effects QL perception, since it has tendency to border mobility, come impair labor activities, in enhancement to causing changes in daily vida activities e sleep pattern88 Green J, Jester R. Health-related top quality of life e chronic venous foot ulceration: part 1. Br J community Nurs 2009;14(12):S12-7.,99 Hopman WM, Buchanan M, VanDenKerkhof EG, Harrison MB. Pain e health-related high quality of vida in people with chronic foot ulcers. Chronic Dis Inj Can. 2013;33(3):167-74.. Constant pain might lead to sociedade isolation, raised expenses with treatment and decreased yield1010 Salvetti MG, de praia IK, Dantas DV, Freitas CC, Vasconcelos QL, torres GV. Prevalência de dor e fatores conectado com em pacientes abranger úlcera venosa. Rev Dor. 2014;15(1):245-8.11 Van Hecke A, Beeckman D, Grypdonck M, Meuleneire F, Hermie L, Verhaeghe S. Expertise deficits and information-seeking actions in foot ulcer patients: an exploratory qualitative study. J Wound Ostomy Continence Nurs. 2013;40(4):381-7.-1212 Costa IK, Melo GS, Farias TY, Tourinho FS, Enders BC, torre GV, et al. Affect of pain on daily life of people with venous ulcers: evidence-based practice. Rev Enferm UFPE ~ above line. 2011;5(spe):514-21..

Studies indicate that a prevalence of pains in VU patient vary from 70 to 90% and this symptom is influenced by socio-demographic determinants related to a assistance and to ns injury99 Hopman WM, Buchanan M, VanDenKerkhof EG, Harrison MB. Pain e health-related top quality of life in people com chronic leg ulcers. Chronic Dis Inj Can. 2013;33(3):167-74.,1010 Salvetti MG, costa IK, Dantas DV, Freitas CC, Vasconcelos QL, torre GV. Prevalência de problema e fatores conectado com em pacientes alcançar úlcera venosa. Rev Dor. 2014;15(1):245-8.,1313 Oliveira PF, Tatagiba BS, Martins MA, Tipple AF, Pereira LV. Reconhecimento da qualificado durante der troca de curativo de ulceras de perna. Texto definição de papel Enferm. 2012;21(4):862-9.. Pains impairs a healing process1414 Woo KY, Sibbald RG. Ns improvement that wound-associated pain and healing trajectory with der comprehensive foot e leg ulcer care model. J Wound Ostomy Continence Nurs. 2009;36(2):184-91. And is uma of a primary reasons para VU patients to look para professional aid1414 Woo KY, Sibbald RG. The improvement the wound-associated pain e healing trajectory with a comprehensive foot e leg ulcer treatment model. J Wound Ostomy Continence Nurs. 2009;36(2):184-91.. In Brazil, however, numerous patients usar personal pain-relief methods, even prior to looking para the ajuda of health professionals1515 Alcoforado CL, santo FH. Sabe e práticas no clientes alcançar feridas: um pesquisar de circunstancias no exército de Cruzeiro a partir de Sul, Acre. Rev Min Enferm. 2012;16(1):11-7.,1616 Budó ML, Resta DG, Denardin JM, Ressel LB, Borges ZN. Praticamente de atenção em conexão à qualificado - a cultura e as escolha alternativa populares. Esc Anna Nery Rev Enferm. 2008;12(1):90-6..

In light of such considerations, it is vital to investigate an individual pain relief strategies supplied by VU patients. Understanding this realidade will enable the identification the failures e the reveja of assistance, aiming at developing der tailored care plan not focused only on the injury. It is precious stressing that efficient pain control may boost treatment adherence rates, in enhancement to boosting QL of such patients1717 Fonseca C, cândido T, filial A, Silva C. . Rev Esc Enferm USP. 2012;46(2):480-6. Portuguese.. So, this study aimed at identifying personal pain relief strategies offered by VU patients.

approaches

This is a descriptive and qualitative aprender carried o fim in ns angiology outpatient setup of a Teaching hospital in the centrais region that Rio compridas do Sul, Brazil.

Inclusion criteria were: having VU, being above 18 years of agir and being treated in ns outpatient setup during the encontro collection period, i m sorry went a partir de January to February 2013. Exemption criteria to be patients com other species of skin injuries and with understanding or communication difficulties.

A semistructured interview, comprised of questions about socio-demographic characteristics and practices/care adopted as são de the start of a injury era used for dia collection, stressing pain-related strategies.

For encontro analysis, interviews were completely transcribed and then submitted to the conteúdo analysis process1818 Gondim SM, Bendassolli PF. Uma crítica da utilização da analisado de conteúdo qualitativa em psicologia. Psicol Estud. 2014;19(2):191-9., by means of 3 stages: pre-analysis, exploration of material e treatment that results, inference and interpretation.

Analysis the gross data obtained são de interviews transcription started with naquela broad reading e subsequently several thorough readings, with which it ser estar possible to reduced record units, until then called by der generic title. Chosen record unidade was of the theme-type, organized and included in categories and sub-categories, which has actually allowed ns investigation of common e diverging points. Then, inference era carried out, that is, ns discussion of obtained data with existing scientific publications.

This pesquisar complied com ethical values of Resolution 466/2012, of the nacional Health Council, which defines ns principles of Bioethics ao studies involving human beings.

The aprender was authorized by the research Ethics Committee of ns University come which it foi ~ linked, under protocol 23081.000145/2008-19.

results

Sample was made up of 14 VU patients, being nine females and five males, aged between 47 e 79 years, most of them above 60 years of age.

Pain was naquela frequent symptom in our sample. Countless patients followed up by a angiology outpatient setup have referred worsening that pain at night and that it would certainly induce sleep changes e mobility limitations, determinants which impact QL.

Pain relief strategies referred by participants ~ ~ presented below, in the following categories: self-treatment and search for the wellness system and religious search porque o pain relief.

Reports show the prática of self-treatment, including pagina inicial practices, self-medication and search ao the health business as pain relief strategies.

Patients have reported using home practices, including the application that physical methods (heat/cold e positioning) for pain relief.

Codes E1 come E14 to be used, where ns letter E intended "respondent" e the number referred to a order of joining in the study.

It era very uncomfortable, most pain, this is horrible, that hurts. At pagina inicial I might not was standing it e I placed my feet in ns water, that smokes, so high is ns fever, so nome é were my legs (E4).

When the is inflamed it hurts a lot, I use an ice cream pack e this relieves. No decorrer one said, I use it, ns don"t use it on a wound yet up here e the fever is gone. Life teaches us to são de things (E9).

I started using alcohol e then this pain was relieved (E6).

When i am laying down I almost são de not feeling pain. Since I felt significant pain and difficulty come sleep, this foi ~ day and night (E6).

As from personal experiences, care practices com regard come pain were emerged by respondents, such as ns use of warm or cold, alcohol and rest.

Still in ~ home, patients have actually referred the prática of self-medication, prática present even when VU patients had access to various health services, such as the Basic health and wellness Unit, outpatient setting, first aid unidade or hospital.

Today that is no hurting, ns had der medicine before leaving home. Ns other dia the wound harms as if it foi ~ being cut with der serrated knife. Doutor said it is poor circulation and that I have to buy medicines . And the health centro does not have this medication (E5).

For pain, lock simply tell friend to have paracetamol, however sometimes I have other, since pain is no relieved. I buy it myself, sometimes I walk to the big center , if a pain is really severe. Mine pain is once I walk, I remover the medicine e it relieves, I settle it through myself, i am supplied to it. What shall ns do? i go to the first aid unit, they provide me an injection and that"s the (E12).

There ~ ~ some dia that pain ... For God"s sake! I have to take der medicine and another one, also yesterday I had actually to walk to ns hospital and they provided me morphine (E14).

We have actually observed the pain, i beg your pardon so lot interferes com QL of together patients, era not adequately cure by health specialists seeing them. Although punctual pharmacological actions to be identified, many reports concertos lack of pains evaluation and monitoring which may negatively influence ns therapeutic scheme. In this sense, a lack the pain control leads VU patients to look porque o other techniques as from their own knowledge and judgment, developed by social e spiritual living.

Religious search para pain relief

Patients have additionally mentioned faith e search ao religious practices as ache relief strategies.

Praying, still today I am praying, I an alert that that relieves once you pray, girlfriend ask para the one up there to help e you need to have faith, because if girlfriend don"t have actually faith, the is useless to pray (E6).

Praying in a Evangelist church. I do it once I have actually lots of pain, there ser estar days once I have actually lots that pain, also with ns treatment of no lowering ns leg, of having actually to remain with the leg raised, laying down, sit down and then i pray e it relieves. That is ns faith we have, if we don"t have confidence <...> (E1).

I just thank God porque o the caminho I am and I don"t complaint, porque o me the is as if I had actually nothing, unless when it damages (E12).

A wonder of God! If you have that belief that you ~ ~ going come win e if you trust God, you have to dedicate com faith. Since God left ns doctors and both run together, doctors com medication e God com His help (E1).

I pray asking God ao health and peace, because I go after remaining things. Help, we have lots of spiritual strength. In general, those quem study a lot, in this instance you doctors, nurses, climate you don"t have actually that spirituality strength, ns believe. Yet we quem have not studied naquela lot, we cling to spirituality strength, because everything the is spirituality is easy e helps us (E2).

Religious practices, such together praying, were generally reported in ns attempt to control or minimize pain, evidencing that there estão failures in the assistance they receive.

discussion

Pain was naquela common symptom amongst participants in this study, in line com systematic análise carried fora by united Kingdom nurses, which has concluded that pain was ns most usual symptom amongst VU patients88 Green J, Jester R. Health-related high quality of life and chronic venous leg ulceration: component 1. Br J ar Nurs 2009;14(12):S12-7..

Studies in France, flor Kingdom and Canada have actually analyzed experience of VU patients e have observed the pain foi ~ constant, with variable strongness along a day and was explained as anguishing, transforming daily life activities and increasing a sensation that isolation1919 Mudge EJ, Meaume S, Woo K, Sibbald RG, preço PE. Patients endure of wound-related ache an international perspective. EWMA J. 2008;8(2):19-28.. Similarly, attendees of this study have reported that pain impairs sleep and mobility, in enhancement to making difficult labor performance.

Pain direção is an essential in the assistance of VU patients e should be naquela concern that health professionals treating this population2020 Santos RF, Porfírio GJ, Pitta GB. Naquela diferença na qualidades de determinação de pacientes com doença venosa cronicando leve e grave. J Vasc Bras. 2009;8(2):143-7.. It foi ~ observed, however, that VU patients very often stand pain and suffering in silence, as result of lack of understanding or ineffective treatment2121 Coutts P, Woo KY, Bourque S. Dealing with patients com painful chronic wounds. Nurs Stand. 2008;23(10):42-6..

Pain may be linked to edema, ischemia, hypoxia, inflammation, epidemic or adherence of dressings ~ above wound beds, concern which foi ~ identified in the evaluation that VU patients, gift referred in ns injury and with center intensity2222 Azoubel R, torres G de V, da Silva LW, gome FV, no Reis LA. . Rev Esc Enferm USP. 2010;44(4):1085-92. Portuguese.. Lessened pain improves ns healing process e favors QL that VU patients2222 Azoubel R, torres G de V, da Silva LW, gomes FV, a partir de Reis LA. . Rev Esc Enferm USP. 2010;44(4):1085-92. Portuguese..

Pain direção is essential component of efficient wound management e health specialists must know significant interventions to handle VU-related pain, giving resolute e tailored care2323 Roden A, Sturman E. Assessment e management of patients com wound-related pain. Nurs Stand. 2009;23(45):53-8..

Participants in this study have reported using simple, however restricted strategies for pain relief. Reports included self-treatment by method of application of physical methods, self-medication and search para health services, and also spiritual/ religious practices. Reports indicate that patients ser estar not oriented about pain relief methods and try to find relief by your own, showing naquela gap in their assistance.

Self-medication may pose risks, because in der situation of severe pain, drugs might be indiscriminately used and in high doses, or even civilization may wait longer before looking for health experts help1616 Budó ML, Resta DG, Denardin JM, Ressel LB, Borges ZN. Realidade de atenção em conectar à agonizante - a lavoura e as alternativas populares. Esc Anna Nery Rev Enferm. 2008;12(1):90-6..

Looking for health services is a most indicated attitude in a situation the VU-related pain. Team following up a injury need to evaluate pain e offer reliable analgesic methods for pain relief. Guidance about pain managing is critical porque o patients to have actually subsidies to minimize pain-related distress. Spiritual/religious methods, i m sorry comfort throughout anguish e affliction times, to be strategies used by patients of this study, an in similar way to naquela study assessing elderly com cancer2424 Rocha LS, Beuter M, Neves ET, Leite MT, Brondani CM, Perlini NM. O cuidado de si de idosos que convivem abranger câncer em curar ambulatorial. Texto contexto Enferm. 2014;23(1):29-37.. Similarly, a manifestation of spirituality, ns belief in der Superior Being, is looked ao to strengthen funil in treatment and wound healing1515 Alcoforado CL, santo FH. Sabe e práticas a partir de clientes alcançar feridas: um aprender de circunstâncias no distrito de Cruzeiro dá Sul, Acre. Rev Min Enferm. 2012;16(1):11-7..

Physical methods ser estar a strategy developing pain relief and are recommended, it is in it by applying bags or pads of warmth or cold, massage or by practicing physics activities1616 Budó ML, Resta DG, Denardin JM, Ressel LB, Borges ZN. Praticamente de atenção em conectar à agonizante - a cultura e as alternativas populares. Esc Anna Nery Rev Enferm. 2008;12(1):90-6..

A pesquisar developed in Australia has tested ns intervention based on sociedade interaction, counseling, support and guidance about preventive care, by means of weekly meetings com VU patients2525 Edwards H, Courtney M, Finlayson K, Lindsay E, nome do menino C, Shuter P, et al. Chronic venous foot ulcers: effect of a community nursing intervention on pain e healing. Nurs Stand. 2005;19(52):47-54.. Results have displayed that ns intervention grupo has considerably decreased pain and the level in ~ which it has impacted mood, sleep and work, in enhancement to considerably decreasing VU size2525 Edwards H, Courtney M, Finlayson K, Lindsay E, lewis C, Shuter P, et al. Chronic venous leg ulcers: effect of a community nursing treatment on pain and healing. Nurs Stand. 2005;19(52):47-54., indicating that multimodal therapies may be effective to direção pain and heal ulcers.

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CONCLUSION

Participants of this study have reported using simple, however limited strategies para pain relief, indicating der lack in the assistance offered to together patients. So, it is necessary to call a attention to a fact the pain is a frequent VU symptom and should be controlled. Understanding strategies offered by patients and offering novo pain control possibilities can be effective method to boost the assistance offered to such patients. This study has shown ns difficulty to handle pain reported by VU patients treated in der Teaching Hospital. Additional studies need to be emerged to confirm such results and to indicate reliable strategies for VU-related pains relief.