squamous cell carcinoma wound pain

[NC29mom, ASN, LPN, RN]

Having a difficult time getting pain managed on a pt with a squamous cell carcinoma facial wound. Current regimen: oxycodone (tried morphine said made too foggy at lowest dose) neurontin, decadron, fentanyl patches) the pain is more neuropathic in nature rt extent of tissue involved. I think methadone would be a good chpice; however, we have such strict regs/rules for methadone, none of nurses want to mess with.

Ive used regenecare in the past...problem is the wound is already so heavily exudating I hate to add more moisture. ....

Any suggestions?

[lmccrn62, MSN, RN]

You should see about any compounding of medications that can be applied to a wound. Often you can create almost anything.

[BostonFNP, APRN]

Considered/tried Cymbalta? We have had excellent results treating refractory neuropathic pain with it.

[NC29mom, ASN, LPN, RN]

You should see about any compounding of medications that can be applied to a wound. Often you can create almost anything.

What medications would you suggest?

[curiousauntie]

I had a patient a few years ago with a very painful wound. We used a morphine get that was placed on the wound bed then the wound was packed. We did it once a day and the caregiver did it in the evening. It helped with the pain, did not get absorbed into the blood, so no drowsiness. But he did not have a lot of drainage at that point, I don't know how the morphine get would work with a heavily draining wound.

We got the suggestion from the Hospice Pharmacia wound team, so if your hospice uses HP, give them a call. They have been wonderful when I needed them. I haven't used them in the past couple of years though, so I actually don't know if it is still an option.

Good luck

[MomRN0913]

Lyrica?

[MomaNurse]

I had a patient a few years ago with a very painful wound. We used a morphine get that was placed on the wound bed then the wound was packed.

I haven't used them in the past couple of years though, so I actually don't know if it is still an option.

Good luck

Have a patient using this now. I have used spray and gel. Gel is tough if there's too much drainage. Also if you have access to a compounding pharmacist, you could really go outside the box. I have used neurontin gel to areas with neuropathic pain. It just depends on what this patient can tolerate.