Non-L.A. pain relief sought for spikes and low-pain thresholders

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I am seeking for ideas for numbing hallux sulci for conservative care where surgical intervention is contra-indicated. I have given Emla for application 2 hrs prior to visit, which patients sometimes remember to apply. BUT wonder what methods other practitioners employ for removal of spikes and general clearance into deep sulci when the discomfort levels seem too high. Freezing? Infiltration of L.A., whisky, mallet on skull, ho, ho ????
Any suggestions gratefully received.

HAPPY NEW YEAR!

 

IMO, Emla is rubbish. Mums are great though . It doesn`t penetrate deep enough. I often use Mepivacaine 3% for removal of painful spikes. I reckon LA is generally underused by most pods. We got the know-how and a shiny certificate so why not make what would otherwise be painful procedures, non- painful?

Cheers,
Bel

 

I agree with Blinda, digital block is the most effective method. I note you mention local infiltration, I presume you mean digital block and not locally infiltrated around the ingrown nail

they only do that in the Emergency Department :bang:

 

And in GP practices. Nice.

 

Always makes them talk though!! Ve haf vays...

I did quite a bit with hypnosis a few years back. It's not for everyone, but it can be ridiculously effective in certain cases, used judiciously. More for nerves than pain. Useful adjunct to LA.

 

Had to be seen to be believed...."Look into my eyes, look into my eyes, the eyes, the eyes, not around the eyes, don't look around the eyes, look into my eyes ...You`re under!". Boy, did that particular pt become...um...dynamic? OK, she farted and talked a lot under hypnosis, yet felt no pain. Just nausea after the `3,2,1, you`re back in the room`. Amazing stuff :drinks

 

Yeah, it does make people fart. Strange but true.

 

Question:

How? Seriously. Why?

 

Stress response. As I understand it the body's response to stress (adrenalin) is to reduce the circulation to the digestive system. Presumably because when you're fighting a sabertooth tiger you really don't need to be digesting.

Hence all the familiar expressions for stress and fear. Butterfly's in tummy, churning stomach, etc.

When you relax, blood supply and peristalsis increases, and things start moving along. You get exuberant gurgles and indeed magnificent trumps!

 

I occassionally use ethyl chloride spray to cool and numb the sulcus before attacking it with sharp things. You need to be quite quick to remove the spike before the site warms up again. Doesn't always work, but I have the stuff close to hand and it is quick and easy to try.

Same principle as freezing before injecting.

Regards,
Ian.

 

Interesting Idea.

I guess you'd have to be a bit careful if you suspected the skin was broken...

 

Hi,
I am a final year pod student, but my dissertation is on the use of Entonox in podiatry.

If the person is needle phobic / anxious or for some reason, maybe infection LA is contra indicated you could use Entonox to reduce the pain/discomfort in pretty much any procedure likely to be performed by pods.

It is self administered (so no over dose) and is 'P' item not 'POM' and is one of the options available to HCP registered Pods with the POM annotation. The effects wear off within a couple of minutes. Very few contra indications assuming your patient has not got a serious head injury, chest injury or the 'Bends' lol. You just need to be competent to use the equipment ( Chat up a paramedic or midwife and remember to complete your Society CPD record form).

Downside you need to spend around £300 to buy the kit as a one off.

For free training on the theory side of things, google BOC Entonox training.

Colin

 

Thanx for all the responses
Ethyl Chloride interests me - sounds to be quick and efficient. Do you know why it doesn't always work, Ian? And are we 100% sure it cannot be used on broken skin? Can anyone point me in the direction of evidence? It's FDA approved for topical use.
Does anyone use biofreeze? I've been told this can be effective too.

Hypnosis sounds interesting - if a little long-winded!!!!! Again I'll be looking for clinical evidence - and fear I may well wander into charlatan territory if I ain't careful.

Entonox also interests me - it will always remind me of childbirth though!!

And yes, blinda, I did mean dribbling a minimal amount of LA around the site of IGTNs (whoops, mind yer 'ead) - having seen this technique used in a 'spike clinic' when a student. I wouldn't dream of using the technique at this stage myself tho'.

If anyone else has any helpful suggestions for topical pain relief in the conservative treatment of painful involuted nails and preventative treatment for IGTNs (where surgery is contraindicated) they would be most welcome.

 

Just seen Guy Ritchie`s http://www.thedailymash.co.uk/news/...o-scam-madonna-out-of-500-grand-200810231346/ Holmes. Robert Downey Jnr wasn`t quite seen driving away in an open-top Ferrari laughing like a madman, but you get the picture ...

Anyhoo, yep you could use local infiltration (although that`s probably just as painful as removing the spike without LA) but I actually meant digital ring block. A LOT less painful. I know `cos I spent an afternoon with Steve Wells, experimenting (on me) to see which was the least painful method to administer LA.

Enjoy your weekend :drinks

 

Not all of these are relevant, and I'll be honest, I've not read all of them . But there IS a LOT of evidence out there.

The nice thing about pain is that by definition is is purely subjective. Thus Placebo is a perfectly acceptable (nay preferable) method of managing it. As such there is no need to worry about being a charlatan. Research shows that it works, the mechanism almost doesn't matter.

But if you wanted to read just one, try this one

 

http://en.wikipedia.org/wiki/Chloroethane

http://www.webmd.com/drugs/drug-139...aspx?drugid=13982&drugname=Ethyl Chloride Top

These sites describe that ethyl chloride is used as a short term L.A. One site does say that broken skin is a contraindication (so that answers your question Robert). I admit that I wasn't aware of this, however this seems very strange if it is ok to use for injections and minor surgery?? I started using it because my dentist used it once on me.

Ian.

 

I have also used the L.A dribbling technique, which I found slower than the ethyl chloride, but seemed to work eventually. Problem is you need to keep testing the sore area before operating on it and ethyl chloride is almost immediate.

Ian.

 

Many thanks for the info provided - especially to Robert!!!! That'll keep me busy one greyday!
Hypnosis may well be a valuable additional arrow in my quiver.

Ian - ta, very helpful!

Blinda - I'd simply love a Ferrari! But that ain't gonna happen, great imagery, tho'. Ta. Love that Daily Mash.
JB
:grin:

 

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