pain from chronic venous stasis ulcers

[Sanchik]

Hoping you guys can help me with this one..
86 y.o female w/CHF, COPD, PVD and really bad chronic venous stasis in her LE. Her legs from the knees down are purple and the skin is paper thin with frequent ulcerations. I can't give her nsaids. i can't put topicals/patches on that skin bc it's almost non intact. she says that the pain is debilitating. She is on Percocet for pain and wellbutrin/Xanax for depression/anxiety.
I am thinking Lyrica but not sure. Thoughts?

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[PMR 4 MSK]

Lyrica can increase lower extremity edema, but I'd be willing to try it. Or gabapentin.

 

[deleted185747]

Would a SCS help? Sure it helps angina and vascular claudication pain as well as perfusion, maybe it would help. I don't know if this has been tried.

 

[hyperalgesia]

Hoping you guys can help me with this one..
86 y.o female w/CHF, COPD, PVD and really bad chronic venous stasis in her LE. Her legs from the knees down are purple and the skin is paper thin with frequent ulcerations. I can't give her nsaids. i can't put topicals/patches on that skin bc it's almost non intact. she says that the pain is debilitating. She is on Percocet for pain and wellbutrin/Xanax for depression/anxiety.
I am thinking Lyrica but not sure. Thoughts?

I might try a benzocaine topical spray...

 

[ghost dog]

Hoping you guys can help me with this one..
86 y.o female w/CHF, COPD, PVD and really bad chronic venous stasis in her LE. Her legs from the knees down are purple and the skin is paper thin with frequent ulcerations. I can't give her nsaids. i can't put topicals/patches on that skin bc it's almost non intact. she says that the pain is debilitating. She is on Percocet for pain and wellbutrin/Xanax for depression/anxiety.
I am thinking Lyrica but not sure. Thoughts?

Gastric bypass.

 

[lobelsteve]

Percocet and Xanax.

Add Soma and dump her to a pain doc.

Get ABI. Ulcers don't hurt. Either pn or pad.
Change out opiate/bzd for 10mg Pamelor. Her kids and grandkids will be pissed you took away their supply.

 

[W222]

Refer her to a vascular surgeon for amputation.

 

[Jitter Bug]

I agree with lobelsteve, ulcers shouldn't hurt that bad. I bet there's something else. Workup for peripheral neuropathy or PAD as mentioned. I've got my money on PAD, since she already has PVD and I'm guessing she is a skinny smoker.

 

[PMR 4 MSK]

Would a SCS help? Sure it helps angina and vascular claudication pain as well as perfusion, maybe it would help. I don't know if this has been tried.

With that infection risk? Constant open sores.

 

[Sanchik]

Thanks everyone for your feedback. She came to me on the Percocet/ Xanax This a SAR setting. She does have both PVD and PAD. So far vascular isn't doing anything. PN labs so far normal, no way I can EMG those legs.

I have been reluctant to start her on Pamelor due to cardicac issues and it's been banged into my head that TCA are bad for the elderly.
Trying the Lyrica and will try the benzocaine spray next

 

[Jitter Bug]

Sure but benzos and opiates are good for an elderly woman with bad legs? Hello falls risk. With polypharmacy, what's the least bad of your bad options? The goal is giving her some pain relief and keep her from sundowning and breaking a hip. Or getting put into a narc sleep all day and getting pneumonia.

If she's been on Percocet and xanax since 1967 you may not win that battle. If she's not tied to them I would definitely try Gapapentin or Lyrica. If she's not too sedated or constipated from the Percocet I wouldn't be against keeping it on too.

The benzocain spray will only help for a few minutes, don't bother. (except before a dressing change, or wound exam)

 

[drf]

Might be worthwhile looking at the European SCS literature for CAD/PVD. I can't recall right now if they discussed infection risks with ulcers. But it definitely works for the pain as well as increasing circulation.