Opioids provide pain relief by mimicking the body’s natural pain relief (endorphins). They are used when the pain is moderate to severe after an operation or accident. They are also used at different stages of illness.

Opioid medicines can help manage some, but not all types of pain, and they will be prescribed by your medical team in hospital or your GP if it is felt they are the best treatment for your pain.

Opioid medicines can help manage pain when other medicines are not suitable, or do not provide enough pain relief. They may help reduce your suffering or distress, and may improve your ability to function physically and socially. They may also allow you to sleep and eat better. 

The correct dose of any medicine is the lowest dose that produces a noticeable benefit. It is unusual to get complete relief of pain from opioids.

However, it is important to find the most effective dose for you to reduce your pain. The amount needed to control pain varies between people. There is no standard dose of opioid.

It is important to understand that the medication/opioids prescribed for your pain may not completely stop your pain – this is normal. The aim of these opioids is to make pain manageable, so you are able to carry out normal daily activities.

You will usually start with a low dose and gradually build up until you find the dose that helps with your pain. The doses can be changed, and other pain medicines can be trialed so your pain is kept under control. Your doctor may try more than one kind of opioid if one type is not right for you.

It is important to control background pain, which is constant and continuous, so you will take a dose at a regular time each day to prevent the pain building up again.

You may have additional medicine for breakthrough pain, which is a sudden, intense pain in addition to the background pain. This will be a short acting preparation (“immediate release”). This acts quickly but usually wears off within a few hours.

It is important to take your pain medicines as they are prescribed.

If it is almost time for your next dose, skip the missed dose and take your medication as normal (you must leave the prescribed number of hours between doses).

Never take two doses together.

If you are using opioids but are still in pain, the opioids are not effective for your pain control and should be stopped by your doctor. Please seek medical advice on weaning opioids if they are not helping to manage your pain- they should not just be stopped.

• Morphine/morphine equivalent medication doses that are 120mg or above per day (24 hour period) greatly increase the risk of harm caused to your body. Research shows there is no increased benefit to pain control above this 120mg total dose.

If you have significant pain after surgery and are sent home with an opioid prescription, it should be limited to a small amount. If you do take opioids, take them only for a day or two, three days at most. Your pain will improve significantly within a few days whether you take opioids or not.

While opioids can have a positive effect for some people living with long-term pain, research shows that opioids have little to no benefit for nerve pain.

Taking opioids long term can have serious consequences when they are not providing enough benefit or are being taken not as prescribed. It is important to consider the risks and benefits of continued opioid therapy with your prescriber on a regular basis.

Recent medical research suggests that the risks to your health increase significantly when taking prescribed opioids at high doses for a long period of time. Health risks include accidental overdose or even death.

When you first start taking opioids you can experience some side effects, which usually stop after a few days. These include:

• Feeling dizzy.
• Feeling sick (nausea).
• Being sick (vomiting).
• Feeling sleepy.
• Feeling confused.
• Feeling constipated.

Please let your doctors know if you experience any of the above. Some side effects can be helped with other medication or alternative pain medication may need to be changed.

It is important to take pain medicine for the shortest possible time. If you want to try reducing your dose, you should discuss this with your doctor and bring the dose down slowly.

Many people find they can reduce their opioid dose without the pain increasing. As fewer side effects are experienced, quality and enjoyment of life can improve. All of this contributes to greater physical fitness.

Following surgery, many patients go home with an opioid pain medicine prescription, this can sometimes trigger addiction.

It is strongly recommended to only take opioids for the shortest possible length of time. Everyone prescribed any pain medication should have them reviewed by their prescriber at regular intervals.

Remember:

• Opioid medicines should be used as little as possible, if at all, after surgery.
• Nobody should need to take them for more than a week after an operation.
• Addiction can develop after taking just a few of them.

People who are addicted to pain medicine can:

• Feel out of control about how much medicine they take or how often they take it.
• Crave the drug.
• Continue to take the drug even when it has a negative effect on their day-to-day life, physical and/or mental health.

If you have been taking opioid pain medicine for more than a week, your body may have become used to the opioid medicine and you may experience symptoms of withdrawal (sweating, stomach cramps, diarrhoea, aching muscles) and the return of your pain if you:

• Stop taking it too suddenly.
• Lower the dose too quickly.
• Run out of medicine.

You should not suddenly stop taking your opioid medicine but get advice from your doctor who will help you reduce the dose gradually and safely.

• If you are allergic to any medications.
• If you are taking any other medication, including over the counter or herbal medication (sometimes different medications can interact with each other).
• If you are pregnant or breastfeeding, or if you are planning to become pregnant in the near future.
• If you have kidney and/or liver problems.
• If you have or have previously had a history of excessive alcohol use, recreational drug use, or addiction to prescribed or over-the-counter medication.
• If you have a condition called obstructive sleep apnoea - it may not be safe to take opioids with this condition.

It is important that you read the drug information leaflet provided with your medication on discharge. This includes more advice on driving and alcohol use along with your medicines.

Taking alcohol and opioids together will cause sleepiness and reduce your ability to concentrate. When you first start taking opioids or when your dose is increased you should be more careful. When you are on a steady dose of opioid, you should be able to drink safe and modest amounts of alcohol without getting any extra unusual effects.

When you are taking opioids, you should not drink alcohol if you are going to drive or operate machinery.

UK law allows you to drive if you are taking opioid medicines. However, you are responsible for making sure you are safe to drive.

Because opioid medicines can make you feel sleepy, you should not drive or operate machinery until you see how it affects you. Your reactions and alertness will be affected. You should only consider driving regularly if you are confident that your concentration is not impaired. You should not drive if your dose has changed or if you feel unsafe. You do not have to inform the DVLA that you are starting an opioid. However, there may be other information about your illness that the DVLA needs to know.

If you have a history of chronic/long term pain and you are taking pain medicines for this at home before coming into hospital, your analgesia/pain relief will be discussed with your doctors/anaesthetist, and/or (if required) the acute pain team. 

It is important that only you take the opioids prescribed for your pain.

Opioid medicines should be kept in their original containers and clearly labelled. They should be stored as the information leaflet given with the medication suggests, usually at room temperature in a dry place.

As with all medicines they should be stored safely out of the reach and sight of children.

• Return them to the pharmacist/pharmacy for safe disposal.
• Do not share these medications with anyone, they are prescribed for you only.
• Do not flush them down the toilet or throw them away.

Resus is for the most critically unwell patients with life or limb-threatening conditions.
 

Majors is for acutely unwell patients who require regular monitoring.

See and Treat is our Minor Injuries Unit (MIU), and where most injuries get seen. 

The minor injury unit can see both children and adults. 

It can treat patients with minor injuries such as cuts, sprains, minor burns and suspected broken bones. 

We do not have a dedicated Minor Injuries team overnight, and all patients will be seen in the ED, along with the Majors and Resus patients. 

This means that after 1 am, patients with minor injuries may wait considerably longer than they would normally.

If you have a minor injury or illness overnight, you will be seen in order of clinical need alongside ambulance arrivals and emergency patients. 

At present, waiting times are much longer overnight, and you may be asked to come back the following morning, or to attend another suitable service instead. 

Other Minor Injuries units are at Yate MIU, Clevedon MIU and South Bristol Community Hospital.

The ED Observation Unit is a seated assessment area for ambulatory patients who are well, but may need further observation and treatment.

If you are unlikely to require admission to hospital, and are waiting for results, need further treatment and/or observation, you will be transferred to our seated monitored waiting area (EDOU).

Occasionally, depending on the results of certain investigations, patients may need admission to a specialised ward from the EDOU.  

The EDOU also has capacity for two surgically expected patients, this means you may be referred directly by your GP to the EDOU, depending on your GP assessment.

In the current climate, waiting times in the Emergency Department can be very long, and for many people, an emergency department is not the best place to be seen. 

The Senior Streaming Nurse may decide your condition does not need to be seen in the Emergency Department and may direct you elsewhere. 

This may happen if our team thinks your condition is not an emergency, or you have certain symptoms which mean you need to be seen by another healthcare provider.

You may be redirected to 111 (link to phoning 111 in the Emergency Department), local Minor Injuries Units (Yate and Clevedon), your GP, local pharmacies, Same Day Emergency Clinic (SDEC) (based at Gate 36, Level 1 of the hospital) or Bristol Children’s Hospital Emergency Department.

We have a few groups of knitters who work hard behind the scenes to contribute items for our patients.  

Sharon says “I chose to knit the cannula sleeves as they are easy but fun to knit, you follow guidelines but can vary the patterns and colours and add different “twiddles”, so it doesn’t get boring. My father and my mother-in-law both lived with Dementia, and it feels good to help others with similar experiences.” 

The Rodway Rubies WI knitting and crochet group are also generous contributors making blankets, twiddle muffs, teddies and other items in abundance, going through bags of wool. They enjoy being able to give something to the hospital community. 

In 2024-25 our knitters and crafters produced 635 items for our patients including 142 lap blankets, 85 teddies, 260 twiddle muffs and 81 cannula sleeves.  

John is Chair of the NBT Patient and Carer Partnership Group. He was also a volunteer during the pandemic, throughout all the lockdowns, delivering medication from the Pharmacy to the wards around the hospital. As a Patient and Carer Partner, John gets involved in a variety of activities from being on interview or award panels to giving feedback on policies, strategies or patient-facing information. 

Joyce and Steve with Maudie 

Joyce and Steve love to volunteer with their dog Maudie and our patients and staff love when our furry friends come visiting. Pets As Therapy Volunteers are dedicated pet owners who visit our patients and staff with their pets. Joyce and Steve love the joy it brings to patients and them in return too.  

Fiona with Millie

Fiona and Millie also volunteer with us in conjunction with Pets As Therapy. The value of pet ‘therapy’ and animal visits is widely accepted as a powerful aid to stimulation and communication. Studies have shown the presence of companion animals can improve the wellbeing of patients and lower the rate of anxiety, simply by making the hospital environment happier, more enjoyable and less forbidding.    

Here are Sandra, Daphne and Rosemary – Shop Manager and volunteers at Southmead League of Friends. The League of Friends has been supporting Southmead Hospital for 47 years by funding requests for the benefit of patients and staff, with most of its money coming through the coffee shop just around the corner from this photo. They don't just provide reasonably priced refreshments, but a friendly face and listening ear to staff and the public. To date the League has funded over £1.8million of requests for the hospital and look set to reach £2million this year!    

Ron is a befriender and helps keep our allotment in great shape! Ron volunteers on the Stroke Ward and visits patients. He shares his experience of having a stroke, which can provide hope and reassurance. He also provides a friendly face and a relaxed conversation, usually telling people about the pumpkin he planted that went missing! Here you can see Ron in the shed by the allotment which is just behind the new Surgical Centre and open to anyone to have a little wander around and sit in the sunshine. 

Jenny is also a befriender on the Stroke ward. Jenny was a patient following a stroke in 2022 where she was visited by fellow befriender Ron (also photographed) who inspired her to volunteer. Although Ron only discovered this during this photoshoot when they both had a lovely catch-up in between modelling for photos! Jenny is a friendly face to patients, she’ll point to the bed and tell her story. Patients discuss their own experiences and see her as a role model to recovery. A highlight was when Jenny saw the physiotherapist who taught her to walk again once she was back as a volunteer, and he was delighted to see her walking so well. 

Moss is a Move Maker and can be seen driving the Buggy here in the Atrium. As a photographer himself Moss has many talents including contributing to the journeys of 40,000+ patients who have been driven by the buggy this past year alone. Our Move Makers help direct people from the entrance but also drive, wheel or sight guide patients to where they need to go. They really make sure our patients and carers are supported on their journey in the hospital.

Becky is a Patient Partner who joined after her experience with our Maternity department. Becky likes that volunteering is a small opportunity to give back to the community. It is also a chance to use her voice and support other patients. She also supports by giving feedback on patient-facing information and carrying out walks around the ward to evaluate the environment to ensure good patient experience in all areas. Becky says, “part of the reason I wanted to volunteer was coming from a minority group my experience with the maternity department was very good and I also wanted to get that side across. I believe when I joined, at the time, there was a lack of diversity from people wanting to volunteer and it was something I wanted to represent in a positive way.” We are grateful to have Becky as a partner. 

Jackie is a Ward Support Volunteer for the Percy Phillips Ward in Maternity. She joined us whilst in the UK for a year as she wanted to give back to the community and try something new. Jackie commented on volunteering at NBT: “The experience has been amazing. The staff have been very welcoming. They are all so hardworking. I enjoy the little things I can do to help them. I would say, the highlight of my shift is interacting with the patients when I visit them with the tea trolley.”

Here are some of our Volunteer Musicians. We currently have 82 active volunteer musicians. They have gifted us 687 hours of music in 2024-2025. They also won the recent ‘We Support NBT’ Award at the NBT Staff Awards. The youngest musician started volunteering at seven years old and can be seen in the group photo with his two siblings. Some of these volunteers have supported us for over 20 years! Our musicians bring so much joy to patients, visitors and staff, with many commenting through our feedback methods or directly to them at the end of a song.

Annie volunteers as Ward Support at Gate 24. She also volunteers with several other groups in Bristol some of which include Caring in Bristol and running a litter picking group in Bishopston. We really do have such amazing volunteers at NBT! Our Ward Support volunteers are there for a friendly chat to patients, a listening ear, raising any concerns, making sure drinks are topped up and various other things. They are always supervised and supported by our staff. 

Emily is one of our peer mentor volunteers. She loves giving her time to people and being a listening ear to those that haven't felt heard. Our peer mentors support others living with a similar condition. We have 11 different groups who use their lived experience to signpost patients to help their recovery or manage their symptoms.  Peer Mentoring offers an opportunity to have a one-to-one chat and share personal experiences and stories either face to face or over the telephone. It is intended to complement the care and education patients and carers receive from the healthcare team and we are so grateful to our volunteers for supporting as peer mentors.   

Sue is a Purple Butterfly volunteer, supporting patients and their families who are experiencing end of life care. This role works closely with our Palliative Care staff team. At this difficult time, they can offer one-to-one support, compassionate listening, comfort and companionship. Each visit is unique; sometimes silent company or just a gentle presence is all that is needed. The volunteers can offer respite so that the patient’s visitor is able to take a short break away from the bedside, in the knowledge their loved one is not alone. Part of the volunteer’s role can include reading, playing music, simply chatting or sitting in silence.

Tim and Anita are two of nearly 100 Move Makers who help patients and visitors navigate our hospitals. They stand out with their wonderful bright pink tops and matching trainers. Tim and his wife Anita decided to become Move Makers in honour of Tim’s sister Kay who was not only an amazing sister but also one of the original Move Makers. Anita loves meeting inspirational patients and says, “it is an amazing experience, every shift is different”.

Katie joined NBT as a Living Well Volunteer after being supported by NBT herself. Through this role she supports other young women with Breast Cancer. As a Patient Partner she gets involved in a variety of activities. More recently this has been our Patient Conversations which is our way of getting live feedback while someone is either an inpatient or outpatient waiting for their appointment. Katie will have an informal chat with our patients and carers to see how their experience is going and then be able to feed that back to the department. If there is anything that can be improved in real time, we aim to do this or take on the feedback for the future.

Martin volunteers with our Discharge Lounge at Gate 24. He volunteers for enjoyment and is valued by the team. Martin supports and provides a ‘listening ear’ to both patients and their families who are being discharged after stays or appointments in hospital and who maybe are experiencing a wide range of emotions at this time. Being a volunteer at NBT is always interesting, worthwhile and Martin says he highly recommends it!

Liz volunteers with our Macmillan Wellbeing Centre. From meet and greet to providing refreshments, craft workshops and Christmas stalls, she is an all-round star. She started volunteering at Frenchay Hospital when she retired, teamed up with her friend, the late Pat Webb, and they both came to Southmead at the same time. Liz creates beautiful paper flowers, some of which have been used as a bouquet for a hospital wedding. She also provides monthly craft sessions for cancer patients.

Julia is an honorary chaplain and Maria is a chaplaincy volunteer. They are both based at the Sanctuary at Gate 30 but they visit all across the Hospital providing a listening ear to anyone who needs them, whether the person is religious or not.  Julia shared, “I am constantly learning from all I come into contact with whilst working within the Chaplaincy team.” All chaplaincy volunteers are trained to support spiritual, pastoral, and religious care for people in the hospital.

Anela is a Patient and Carer Partner. She got involved with NBT through the Bristol Sight Loss Council and has done a huge amount across the Trust to improve access for those with a visual impairment. Her work involves delivering sight loss awareness training to staff, advocating for and testing accessibility for our Digital Patient Engagement projects, reviewing and supporting new projects looking at the physical space and more. She also sits on the Patient and Carer Partnership group which involves feeding into meetings, projects, policies and various work to ensure NBT represents all the Patients and Carers it serves.

Richard is one of three volunteers who work with our Major Trauma Team. The volunteers make phone calls to patients two weeks after they’ve been discharged from hospital. On the calls the patients are asked a standard set of questions to assess how they are managing and get feedback from their time in Southmead Hospital. Any concerns or questions raised by the patients in the calls are fed back to trauma practitioners who call the patient back to resolve any issues. Feedback from the calls is compiled into quarterly reports and passed back to the clinical specialties to contribute to continual improvement of the service.

Megan volunteers as a Ward Support on Ward 27A Cardiology. For Megan, volunteering has given her the opportunity to work within a medical environment, which she wants to pursue as a career in the future. “Volunteering is a great opportunity to learn new things and experience an area you may wish to move into in the future”, she said. Megan is off to University in September and we wish her all the best. Who knows, we may see her back as a Staff Member at NBT in the future!

Dai is a Patient Feedback Volunteer. Our Feedback Volunteers help with any current surveys we have and with Patient Conversations. Dai speaks to a variety of patient and carers across the hospital, to understand how their experience has been. This helps the different departments and wider Trust consider what is going well and what they can improve. Dai says the highlight for him is meeting people whether that is the nurses, doctors, patients and other volunteers.

Sue is one of the lovely Move Makers who you’ll see when coming into the Emergency Department (ED). We have Move Makers across ED, the entrance to the Brunel Building and at Cossham Hospital. You’ll spot the Move Makers in pink or green tops, and they are always ready to help. Sue volunteered throughout the pandemic, “which was challenging but very rewarding”. She deals with anxious relatives and friends as part of her role and she knows how frightening the ED department can be, so is great at supporting our visitors and giving them a bit of calming reassurance, directions or a cup of tea.

• Varicose veins are veins under the skin of the legs which have become tortuous, widened, and bulging (varicose). Varicose veins are very common and do not cause medical problems in most people.
• Blood flows down the legs through the arteries and back up the legs through the veins. The main systems of deep veins, carry most of the blood back to the heart. The veins under the skin (superficial veins), are less important and can form varicose veins.
• All veins contain valves which should only allow the blood to flow one way. If the veins become widened and varicose, these valves no longer work properly. Blood can then flow backwards down the veins and lead to increased pressure when standing, walking, or sitting. Lying down or ‘putting your foot up’ relieves this head of pressure and usually makes the legs feel better.
• The symptoms and treatment depend on how badly the valves in the veins are working, although the trouble people get from their varicose veins is variable. Varicose veins often appear first in pregnancy, when hormones relax the walls of the veins and when the womb presses on the veins coming up from the legs.
• People who are overweight are more likely to get varicose veins and to find the symptoms troublesome. Bad varicose veins can run in families, but this is not always the case. Usually there is no special cause for varicose veins.
• Varicose veins should not be confused with more superficial spider and thread veins which lie within the skin not deep into it.

• Although varicose veins can get worse over the years, this often happens very slowly. Worrying that ‘they might get worse’ is not a good reason for treatment. Most varicose veins do not require medical attention.
• In a few people high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour, sometimes with scarred white areas. Eczema (a red skin rash) can develop. If these changes are allowed to progress or the skin is injured, an ulcer may form. Skin changes are a good reason for going to see your GP and for referral to a specialist.
• Other problems which varicose veins occasionally cause are phlebitis and bleeding. Superficial venous thrombosis (sometimes called thrombophlebitis) means inflammation of the veins accompanied by thrombosis (clotting of blood) inside the veins which become hard and tender. 
  This is not the same as deep vein thrombosis (DVT) and is not usually dangerous. It does not mean that the varicose veins must be treated, though treatment is recommended for recurrent attacks.
• The risk of bleeding because of knocking varicose veins worries many people, but this is rare. It will stop with firm pressure on the area and the veins can then be treated to remove the risk of further bleeding.

• Many varicose veins do not have to be treated at all unless they are causing serious symptoms, such as recurrent phlebitis, bleeding, or ulcers.
• If simple measures have failed and the symptoms from your veins are significantly affecting your quality of life you should consider a surgical procedure. All procedures have their risks; deaths from blood clots passing to the lungs following vein surgery has been reported (see Deep Vein Thrombosis below).
• Aching, itching, and heaviness of the legs can often be relieved by support stockings or tights. Your GP can prescribe firmer and more effective ‘graduated compression stockings’ if ordinary ones are not helpful enough, these usually need only to be below the knee, rather than full length stockings.

• Varicose veins can be dealt with by injection treatment (sclerotherapy). An irritant substance is injected into the veins which causes local inflammation and seals off the vein.
• Larger varicose veins may be treating using radiofrequency ablation with or without foam sclerotherapy - this is a surgical intervention which uses radio waves. We rarely do open surgical stripping of the veins as newer techniques are as effective, less invasive, and have a shorter recovery time. The treatments we offer are “walk in walk out” procedures and you will not need to stay in hospital.

• Injections by foam sclerotherapy using ultrasound guidance is a newer technique that allows larger veins to be treated.
• Several needles may be required to complete one treatment. Some patients need more than one treatment session.
• The foam is made by mixing air with an irritant substance (we use a product called Fibrovein™). Your leg is then elevated and you are asked to move your foot up and down to keep the blood moving in the deep veins.
  The foam is injected and followed as it moves along inside the vein using the ultrasound. Pressure is applied for a few minutes over the vein and a firm compression stocking is fitted and worn for 2 weeks.
• Foam sclerotherapy is an alternative to a surgical procedure tying off the vein (‘high tie’) and removing the vein surgically (‘stripping’).
• Although foam works effectively, long term results are unknown. Recurrence of varicose veins should be considered and may require future treatment.

• Not all veins are suitable for foam sclerotherapy treatment. During assessment of the veins we use ultrasound to see if foam can be used to treat.
• Foam sclerotherapy works by destroying the lining of the vein. This causes the vein to shrivel up and your body absorbs the remaining tissue over time. You may notice some discomfort or discolouration of the skin.

• We aim to do any procedure within 18 weeks from the time you were referred by your GP. We do not like to keep people waiting for a long time but have to deal with patients based on medical priorities. Those with more serious symptoms such as skin changes or ulcers are prioritised.
• Delays are caused by heavy demands on staff and resources. There are particular problems dealing with varicose veins because large numbers of patients are referred. This means there is a limit on the number of operations which can be done, while also dealing with other conditions which are a serious threat to life or health.
• In Bristol and Weston-super-Mare GPs have clear guidelines from integrated care boards (ICBs) for assessment and referral for treatment. Funding for treatment is confirmed before referral.

Most foam procedures are done as a day case. 

The hospital requires you to sign a consent form - as for any operation. 

You will not need to starve for foam injections but avoid a large meal immediately before the procedure. It is important to drink plenty on the day of the procedure as being dehydrated will cause the veins in your leg to shrink. 

You do not need to shave before foam injections. 

Painkillers are not routinely prescribed though you may wish to take paracetamol. 

• Immediately following the procedure you will be able to get up and dressed. You will walk to the recovery area and have a drink.
  Before leaving you will be given discharge information and aftercare instructions. Staff will check your leg for any bleeding, which is usually not much.
• You will be given an advice leaflet following your procedure. A discharge summary will be send to your GP to inform them of your hospital day case stay.
• You will be put in a compression stocking after the procedure with a bandage over the top. We usually ask you to wear both the stocking and bandage for 48 hours - so you will not be able to shower during this time. Following this you should be able to remove the compression stocking and bandage to shower. After you shower put the compression provided back on. You should do this for 2 weeks, only removing the compression to shower and sleep.
• If struggle to get the stocking on and off you can leave it on for a week or two, but you will not be able to shower.

Why wear support stockings? 

Wearing a compression stocking is recommended to reduce the risk of DVT. They can also provide support for comfort and reduce swelling.

When can drive? 

You should avoid driving a car for 24 hours after the procedure.

When can I return to work and play sports?

You can return to most sports as soon as you feel able. Avoid swimming and horse riding for at least a week and until all wounds are dry. 

When can I fly? 

• You should avoid long haul flights for six weeks after the procedure due to the risk of DVT.
• The risk from short haul flights is lower but should be avoided for four weeks after the procedure.

• Serious complications are uncommon. Occasionally the vein may not be completely seal after foam injections. In these cases a further attempt or a standard surgical operation may be offered.
• A small number of patients may experience brief side effects during foam treatment including lower back pain, chest tightness, confusion, migraine, coughing, faintness, panic attack, or visual disturbance. Visual disturbance has been reported by up to 6 percent of patients (6 in 100 patients). There are no reports of long term visual problems following foam treatment.
• Foam injections cause local inflammation which can cause mild discomfort, hard lumps where the veins were and brown staining of the skin. Rarely it is necessary to have trapped blood released a few days following the procedure.
• You are advised to avoid sun exposure for at least 6 weeks following treatment to reduce skin discoloration over the treated veins.
• Very occasionally the injections cause an allergic reaction.
• After any vein treatments tributaries of the vein (smaller veins) may remain.
• Aches, twinges, and areas of tenderness may all be felt in the legs for the first few weeks after the procedure. These will all settle down and should not stop you from becoming fully active as soon as you are able.
• Infection is an occasional problem. It usually settles with antibiotic treatment.
• Nerves under the skin can be damaged by the treatment. This is uncommon, but will give an area of numbness on the leg, which settles or gets smaller over weeks or months. If a nerve lying alongside one of the main veins under the skin is damaged, then a larger area of numbness can be caused. If this happens then numbness will happen over the inner part of the lower leg and foot.
• If a main vein behind the knee needs to be dealt with, then there is a risk to the nerve which gives feeling from the skin on the outer part of the lower leg and foot.
• Deep vein thrombosis causes swelling of the leg and can result in a blood clot passing to the lungs. It is a possible complication after varicose vein treatment, but is particularly unlikely if you start moving your legs and walking frequently soon after the operation.
• If you are taking the contraceptive pill/or are taking HRT, your risk of thrombosis is increased and the surgeon will discuss with you the pros and cons of stopping the pill or continuing it and taking special action to reduce your risk of thrombosis. If you start taking the contraceptive pill while waiting for your procedure, let the hospital know.

Some people develop new varicose veins during the years after a varicose vein procedure. Rarely, varicose veins simply re-grow in the areas which have been dealt with or else they develop in a different system of veins which were normal at the time of the original operation. If veins develop again, they can usually be dealt with by further treatment should they be troublesome.