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What Causes Bone Pain, Tenderness On The Arm Post A Plastic Surgery?
Question: A plastic surgeon performed a wide excision of a melanoma ( said to be an aggressive one but caught at 1.5mm depth ) on my left upper arm 15 months age, also removed and examined the sentinal lymph node from my left axilla. no cancer cells found there. My problem currently is deep bone pain and local exquisite tenderness directly under the 5 inch incision on my arm.. it awakens me in the night within 2 hours of falling asleep and keeps me awake. I am a 57 year old practising physiotherapist/owner of a large clinic and need both my sleep and my arm strength and ROM. I have had my PT's do PT on me and my massage therapists do massage to mobilize the scar and underlying tissue.. these do not improve the pain but have improved the mobility. Tylenol and Motrin have not helped. Is there a topical agent that I could try that would ease the night pain? Maybe I should see the plastic surgeon for a revision of the scar ? Please give your advise.. we have 'free' health care in Canada IF you can ever get in to see a surgeon... so I don't like to ask unless you think it would help.
Brief Answer:
YES, well.. very probably.
Detailed Answer:
1.5 you can't say. ....15 months you can ! Congratulations.
Next, the type of pain, location, what triggers it and its context are all clues to the pathophysiology and how to deal with it. It isn't still inflamed. It isn't a joint or tendon it isn't weight bearing per se. So, irritation/trauma of a very small very localized very shallow nerve can cause pain that is quite severe and highly variable in the individual. Often with a temperature component to it.
nerve dampers work on nerve pain and none are in any way addictive and most are cheap, free of side effects. The most powerful when it works is lidocaine as a patch. It is limited because of how far down the drug gets. If it is at the surface and due to a nerve it is very effective in percent of those it helps and the extent of the pain relief (often very dramatic).
Then the list of pill nerve dampers. Gabapentin and amitryptiline/nortryptiline are two of the most effective and low risk. Pregabalin (no relation to gabapentin huh! who knew!) is another alternative but has an addiction warning. Then there are a lot of other drugs that are maybe's (topamax, dilantin, verapamil, capsaicin, methylsalicylate, etc.).
YES, well.. very probably.
Detailed Answer:
1.5 you can't say. ....15 months you can ! Congratulations.
Next, the type of pain, location, what triggers it and its context are all clues to the pathophysiology and how to deal with it. It isn't still inflamed. It isn't a joint or tendon it isn't weight bearing per se. So, irritation/trauma of a very small very localized very shallow nerve can cause pain that is quite severe and highly variable in the individual. Often with a temperature component to it.
nerve dampers work on nerve pain and none are in any way addictive and most are cheap, free of side effects. The most powerful when it works is lidocaine as a patch. It is limited because of how far down the drug gets. If it is at the surface and due to a nerve it is very effective in percent of those it helps and the extent of the pain relief (often very dramatic).
Then the list of pill nerve dampers. Gabapentin and amitryptiline/nortryptiline are two of the most effective and low risk. Pregabalin (no relation to gabapentin huh! who knew!) is another alternative but has an addiction warning. Then there are a lot of other drugs that are maybe's (topamax, dilantin, verapamil, capsaicin, methylsalicylate, etc.).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much. I'll check out the lidocaine patch and ask to be referred back to Dr Dool the plastic surgeon if significant pain persists.. kind regards.. XXXX
Brief Answer:
You are quite welcome
Detailed Answer:
another possibility is "scar tissue" but that still begs the question of why it hurts.
Ironically, the worst it hurts the more likely that lidocaine (and every other nerve pill mentioned!) will work really really well (because that would mean it's a nerve as mentioned previously).
A slight dull ache from pulling would be a physiological normal sensation from things stuck together. Frankly, further surgery is as likely to increase it as help and local massage to loosen up the area is a better (and cheaper) bet.
You are quite welcome
Detailed Answer:
another possibility is "scar tissue" but that still begs the question of why it hurts.
Ironically, the worst it hurts the more likely that lidocaine (and every other nerve pill mentioned!) will work really really well (because that would mean it's a nerve as mentioned previously).
A slight dull ache from pulling would be a physiological normal sensation from things stuck together. Frankly, further surgery is as likely to increase it as help and local massage to loosen up the area is a better (and cheaper) bet.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Lidocaine and/or gabapentin, and massage.. very doable.. thanks again.. XXXX
Brief Answer:
anytime. glad to help
Detailed Answer:
and, I'm available for further follow ups on this or other questions either through follow up or through direct questions.
anytime. glad to help
Detailed Answer:
and, I'm available for further follow ups on this or other questions either through follow up or through direct questions.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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