A Cochrane review included 8 studies with a total of 813 subjects. Six studies evaluated pain associated with venous leg ulcer treatment. The application of EMLA cream (5% lidocaine-prilocaine cream) before leg ulcer debridement reduced pain measured on a VAS 0-100 mm (MD -20.65 mm, 95% CI -12.19 to -29.11, statistical heterogeneity I² = 53%; 6 studies, n=317) compared with placebo cream or no anaesthetic. No significant between-group differences in burning or itching were observed. Only one small trial (n=43) measured healing as an outcome and found no statistically significant difference in the numbers of ulcers healed at the end of the study.
Two studies (n=470) evaluated ibuprofen slow release foam dressings for persistent venous leg ulcer pain. Compared with local best practice, significantly more participants in the ibuprofen dressing group achieved the outcome of >50% of the total maximum pain relief score between day 1 and day 5 than participants in the local best practice group (RR 1.63, 95% CI 1.24 to 2.15; 1 study, n=348). The number needed to treat was 6 (95% CI 4 to 12). In the second trial, compared with an identical non-ibuprofen foam dressing, there was no statistically significant difference in the proportion of participants experiencing slight to complete pain relief on the first evening of treatment (RR 1.27, 95% CI 0.98 to 1.65; 1 study, n=122). Limited data were available to assess healing rates or adverse events.
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment).