Pain S/P excision skin CA/RadioTx

[pastafan]

92 y.o. male, who appears much younger than his stated age, S/P resection skin CA 3 years ago followed by radiotherapy and then a a skin graft. He has constant pain at site and distally. I just saw him after he has failed multiple meds including opiates. The patient isn't interested in more pills. I tried covering the wound with 1% lidocaine but that did not change his pain at all.

It looks like a combination of radiation dermatitis plus pain from the wound. When he flexes his foot tendon movement is visible that aggravates his pain. Suggestions?

Additional info, I thought they were treating him at university wound center but he has been seeing folks at university but no wound treatment.

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[Orin]

Hyperbaric oxygen +/- sympathetic nerve blocks +/- topical capsaicin

 

[Ducttape]

stem cells.
crush them up and sprinkle away...

 

[painfree23]

Hyperbaric oxygen +/- sympathetic nerve blocks +/- topical capsaicin

Wat would you hope the sympathetic nerve block will do? Improve blood flow and that may help with the pain?

 

[SommeRiver]

Wat would you hope the sympathetic nerve block will do? Improve blood flow and that may help with the pain?

Blood flow and possibly pain

 

[Orin]

Improve blood flow and that may help with the pain?

If there's a radiation induced neuropathic pain state in addition to the nociceptive issues with an open wound, that seems to respond relatively well to sympathetic blocks. The perfusion issue is separate and it may help that, but the sympathetic pain effect is the primary goal.

Hyperbaric oxygen and wound care are number one and two thing here

I suspect that's growing fungus/mold

 

[NOSfan]

HBOT, LSB & 3gm IV Vit. C

 

[lobelsteve]

If there's a radiation induced neuropathic pain state in addition to the nociceptive issues with an open wound, that seems to respond relatively well to sympathetic blocks. The perfusion issue is separate and it may help that, but the sympathetic pain effect is the primary goal.

Hyperbaric oxygen and wound care are number one and two thing here

I suspect that's growing fungus/mold

Not much support for LSB for this problem. But nothing else is working and it is a reasonable and science based effort. I would agree with LSB trial, nothing to lose except time, pain, and his arm. We might help with this. We will not hurt with this.

 

[Orin]

Looking at it again, you could do a saphenous nerve block below the knee there and then RF it if that helps his pain. It's a little crazy, but 60% of the time, it works every time.

 

[painfree23]

Looking at it again, you could do a saphenous nerve block below the knee there and then RF it if that helps his pain. It's a little crazy, but 60% of the time, it works every time.

Pulse RF it?

 

[kstarm]

If it is an open wound you could try a topical morphine gel. 0.1% initrasite gel