Psychological Aspects of Pain at Patients with Critical Limb Ischemia


Peripheral arterial disease is one of the major conditions that affect middle and old aged persons. Its prevalence ranges from 3% (for people aged 37- 69 years old) to 20% (for people aged over 70 years old) (1). In advanced stages (III and IV Leriche) the main symptoms are ulcers and pain- at rest, intolerable, nocturnal increased, needing analgesic treatment (inclusive opiates). Critical limb ischemia (CLI) is characterized by chronic ischemic rest pain, ulcers or gangrene attributable to objectively proven arterial occlusive disease (2,3). CLI is considered like a “malignant” disease – due to generalized atherosclerosis these patients are predisposed to various cardiovascular complications (e.g. myocardial infarction, strokes) which can cause death in few years (4).
The patients affected by CLI are patients generally considered difficult cases, destined to repeated approach to the health care services. Physicians have to take in charge not the pathology but to take in charge the patient. For the control of the pain it turns out essential, near the block of the perception of the pain, to act with psychological participation, in order to interfere with the perception of the pain and the meant one of the pain, modify the feelings associated to the pain, modify the behavior induced by pain (5).