pastafan

Interventional Pain Physician
5+ Year Member
Nov 11, 2012
1,387
579
131
Status
Attending Physician
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.
 

Attachments

Last edited:

Orin

7+ Year Member
Jul 27, 2009
680
252
181
Status
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
 

lobelsteve

SDN Lifetime Donor
Lifetime Donor
10+ Year Member
May 30, 2005
13,408
3,314
281
Canton GA
www.stevenlobel.com
Status
Attending Physician
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

7+ Year Member
Jul 27, 2009
680
252
181
Status
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.