Varicose veins develop due to a condition called chronic venous disease (CVD) or venous insufficiency. The veins are characterized by a reduced capability to transport blood back to the heart against gravity. Varicose veins often appear as twisted, swollen and enlarged structures on the leg. Venous insufficiency is a progressive disease an whilst initial symptoms may be almost unnoticeable, over time the condition tends to worsen and requires medical treatment.
Treatment alternatives for varicose veins
Many treatment alternatives exist for varicose veins and to some extent the individual characteristics of the condition are basis for therapy selection. Some of the most common alternatives and associated pain are described in the following:
Historically, surgery was the only treatment option available. With the so-called “stripping” the damaged vein was cut and pulled out of the leg. Even though, less invasive surgical and non-surgical options exist today, some physicians still use this treatment option.
About 2 decades ago other treatment alternatives including sclerotherapy, thermal ablation and medical glue emerged. Whilst sclerotherapy treats through injection of a medicine into the vein which destroys the vein wall and thereby leads to their collapse, thermal ablation techniques are gentler and don’t rely on medical injection. Thus, thermal ablation techniques are established in routine clinical practice and are nowadays recommended as preferred treatment by official authorities like the NHS in the UK. You can learn more about the three available ablative techniques here.
Pain of treatment options
Surgery
Surgeries are always carried out with local or general anesthesia in order to relief unpreventable pain of the procedure. However, even after the treatment wound pain and pain in area from which the vein has been removed is common. Thus, further pain medication may be required. Research has shown that post-operative pain tends to be higher for surgery compared with endothermal ablation with laser or sclerotherapy treatment.
Sclerotherapy
Sclerotherapy is a simple and cheap procedure. It results in less post-operative pain compared to surgery. During the treatment local anesthesia may or may not be used. How painful the procedure is can depend on the sclerosant (injected medicine) used as it can vary with different products.
Endothermal ablation (with catheter)
Research has found that laser ablation causes similar post-operative pain to surgery and tends to be significantly higher compared to ablative therapy with radiofrequency. Endothermal ablation tumescent anesthesia which is injected prior to treatment around the vein is required in order to compress the vein. The administration of the tumescent anesthesia can be uncomfortable and sometimes painful.
Echotherapy for varicose veins
Non-invasive thermal ablation (without catheter)
The Echotherapy is the only non-invasive thermal ablation method. It does not require a catheter. Experiences have shown that the short ultrasound pulses that generate the heat to close the vein can feel uncomfortable and slightly painful. Thus, physicians usually give some oral or local pain medication to relief any discomfort. After the treatment, there is usually no pain and daily activities can be resumed at once.