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Thread: Residual pain at wound site...not sure when to start sitting again??

  1. #1

    Residual pain at wound site...not sure when to start sitting again??

    Hello all, I did a search but couldn't find a real answer to this question, so I am going to ask it here.

    A few months ago, I had a small wound right near the tailbone (here is the thread for reference including pictures). It seems to be healed up, but there's still a little bit of pain. The pain is located in the exact same area it's always been; over time it has subsided, but it's still there. Some days I wake up and don't really feel it - I feel exactly the same way I did before the wound, but then I'll wake up the next day with the pain having returned.

    I have forced myself to be on 100% bedrest this entire time. My motivation is that I would prefer to suffer in the short-run rather than have any small chance of this becoming an issue again.

    My question is when I should begin to sit again. While I know that bedrest is very important to heal up and completely resolve wounds, I also know that being in bed 100% is not good in and of itself.

    So, how do I approach this? Is it one of these situations where I just have to bite the bullet and sit and see how it looks afterwards (inspect for redness/trauma) or do I trust my pain and wait it out on bedrest even longer?

    I guess what I am trying to say is that I am not sure if this is a pain indicative of true underlying inflammation, or if it is "phantom" pain similar to some of the other pain that comes with SCI. Perhaps only superficial portion of the wound has resolved, but there is still some deeper trauma that is resolving which is where the pain is coming from? I'd hate to put the ongoing healing of the deeper tissue at risk because I wanted to sit earlier than I should have.

    Another question I have is if there are any others out there who have successfully healed a wound, to then have residual pain in the exact area long term.

    Apologies ahead of time for the long-winded post.

    Some ancillary information:
    - I believe the wound was caused by a rushed transfer onto the flat, non-open bench part of my shower commode. I discovered this wound in the afternoon, so I can't be 100% sure it was this transfer (I do BP at night), but I can't possibly think of anything else that could have caused it.
    - Sometimes, a certain pattern in the pain emerges: there will be a little bit of pain there throughout the day, I'll have my bowel program in bed, then following the bowel program the pain subsides and then I'll wake up the following morning with a noticeable increase in the pain.
    - Each time I had a rough BP (prolonged/more than the usual amt of dig stim), the pain level the next day is elevated.
    - The avg pain level is around a 4/10. It isn't unbearable, but it would make sitting uncomfortable.
    - CT scan of sacral area came back unremarkable; had additional MRI done to 100% rule out anything underlying, but I am still awaiting results.
    No one ever became unsuccessful by helping others out

  2. #2
    Quote Originally Posted by Tufelhunden View Post
    Hello all, I did a search but couldn't find a real answer to this question, so I am going to ask it here.

    A few months ago, I had a small wound right near the tailbone (here is the thread for reference including pictures). It seems to be healed up, but there's still a little bit of pain. The pain is located in the exact same area it's always been; over time it has subsided, but it's still there. Some days I wake up and don't really feel it - I feel exactly the same way I did before the wound, but then I'll wake up the next day with the pain having returned.

    I have forced myself to be on 100% bedrest this entire time. My motivation is that I would prefer to suffer in the short-run rather than have any small chance of this becoming an issue again.

    My question is when I should begin to sit again. While I know that bedrest is very important to heal up and completely resolve wounds, I also know that being in bed 100% is not good in and of itself.

    So, how do I approach this? Is it one of these situations where I just have to bite the bullet and sit and see how it looks afterwards (inspect for redness/trauma) or do I trust my pain and wait it out on bedrest even longer?

    I guess what I am trying to say is that I am not sure if this is a pain indicative of true underlying inflammation, or if it is "phantom" pain similar to some of the other pain that comes with SCI. Perhaps only superficial portion of the wound has resolved, but there is still some deeper trauma that is resolving which is where the pain is coming from? I'd hate to put the ongoing healing of the deeper tissue at risk because I wanted to sit earlier than I should have.

    Another question I have is if there are any others out there who have successfully healed a wound, to then have residual pain in the exact area long term.

    Apologies ahead of time for the long-winded post.

    Some ancillary information:
    - I believe the wound was caused by a rushed transfer onto the flat, non-open bench part of my shower commode. I discovered this wound in the afternoon, so I can't be 100% sure it was this transfer (I do BP at night), but I can't possibly think of anything else that could have caused it.
    - Sometimes, a certain pattern in the pain emerges: there will be a little bit of pain there throughout the day, I'll have my bowel program in bed, then following the bowel program the pain subsides and then I'll wake up the following morning with a noticeable increase in the pain.
    - Each time I had a rough BP (prolonged/more than the usual amt of dig stim), the pain level the next day is elevated.
    - The avg pain level is around a 4/10. It isn't unbearable, but it would make sitting uncomfortable.
    - CT scan of sacral area came back unremarkable; had additional MRI done to 100% rule out anything underlying, but I am still awaiting results.
    I can't speak to the pain you are experiencing, but your doctor should be able to tell you when you can begin a seating program or schedule and what schedule he wants you to follow. The schedule may start with sitting in your wheelchair for as little as five minutes in the morning, then checking the area for redness, resting, and then sitting for 10 minutes in the afternoon of the same day. This will go on increasing by five or ten minutes each time you attempt to sit. The final stage of the program is working up to sitting for four hours, resting one hour, then sitting for four hours. Once you have achieved that milestone with no signs of more injury, you are usually good to resume a typical day of sitting. But, your doctor should be the one to make this decision.

  3. #3
    How long has the pressure injury actually be completely closed? Is it possible to post or send the SCI-Nurses a photo of the area? Is this an area where you previously had sensation or neuropathic pain?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    Quote Originally Posted by SCI-Nurse View Post
    How long has the pressure injury actually be completely closed? Is it possible to post or send the SCI-Nurses a photo of the area? Is this an area where you previously had sensation or neuropathic pain?

    (KLD)
    Thanks for the reply KLD. I will go ahead and forward a picture to the SCI nurses.

    When the wound was discovered originally, I'd estimate that the length was the width of my thumbnail. In terms of how wide it was, it was more of a slit (I think caused by shearing when I rushed that transfer to the shower commode). It seems that it closed up very quickly and was 95% closed within two weeks, according to my PCP in Rhode Island. I don't really know how to explain the rest of this, but that remaining 5%, which the PCP said resembled a superficial skin fissure seemed to migrate towards that huge scar over my gluteal cleft from a sacral sore I had when I was originally paralyzed 13 years ago.

    That last bit (this 5%) has been the bane of my existence for the last 2.5 months. From reading the posts here, I really pushed my primary doc to order further testing; I thought there may be a slim chance the bone was infected which would explain the stalling in the complete healing of this. So after a CT scan, blood tests and a recent MRI, nothing seems to indicate there is anything wrong in the underlying tissue.

    I wanted to be on 100% bedrest, so I flew out to CA on the 5th of December as my mother said she wouldn't have any problems cooking my food and helping out with my BP program in bed. I'm sure the cross-country flight probably didn't do me any favors, but I was out of options and figured the risk was worth the benefit of being on complete bedrest.

    Another good thing is that my mom's been able to keep an eye on the healing process. According to her (and what I could see from a mirror I rigged) it looked like the skin in the area kept shedding a bit. But this "new skin" covers an area far larger than the original wound, which If you look at the pics I posted in my original thread that I referenced above, looks like no big deal. You can actually see how small it is compared to that menacing wound from the stage IV ulcer complete with the MRSA cherry on top I healed up from (which only took ~5 months without flap surgery, btw).

    This has partly been the reason for my frustration. Funny enough, the doctor who I saw the day after I discovered the wound said I'd probably be able to be back at work probably within a week....yeah right.

    I have always had continual pain from the rectal area probably due to hemorrhoids and all the other trauma that goes with it, but the pain I am describing is definitely new - it wasn't there before this wound opened up in late October of last year.
    No one ever became unsuccessful by helping others out

  5. #5
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    I think you over analyze. It's just neuropathic pain. I had an ischial flap surgery performed in April and the area is painful from time to time. The longer I sit, the more painful it is. To be honest, I'm glad it hurts because that's an indication of too long sitting without pressure releases or too long sitting at all. Is your pain constant? I experience mine only after prolonged period of sitting. I saw the photos you posted - all I see is pink scar tissue. I think you should chill out but be very vigilant about the area and observe if it gets red/irritated after sitting.

  6. #6
    Quote Originally Posted by K_Soze View Post
    I think you over analyze. It's just neuropathic pain. I had an ischial flap surgery performed in April and the area is painful from time to time. The longer I sit, the more painful it is. To be honest, I'm glad it hurts because that's an indication of too long sitting without pressure releases or too long sitting at all. Is your pain constant? I experience mine only after prolonged period of sitting. I saw the photos you posted - all I see is pink scar tissue. I think you should chill out but be very vigilant about the area and observe if it gets red/irritated after sitting.
    I reflected a lot on your post, K_Soze. So yesterday, I received my MRI results (came back fine) and I got up in the chair for an hour and pretty much practiced the piano the entire time. I made sure to take a couple of pictures of the area right before I got up and right after I went back to bed. I compared the two and couldn't really tell them apart, which tells me that I think you're right.

    Today, I got up around lunch time and puttered around the house, and stayed up even having dinner in the kitchen instead of in bed (I'm thinking like 3-4 hours). Did the same comparison with before and after photos. Same result. So, at this point, I think I can objectively say that most of the pain I have been experiencing in the area is primarily neuropathic rather than the wound complaining about pressure.

    Is there any type of cream/lotion I should be placing on that pink scar tissue in order to strengthen it as much as possible at this point? Should I be doing anything physical to it like lightly massaging it? All I have really done is a lot of stretching of the legs/hips in order to both get my range of motion back and to "stretch" the new skin so it doesn't remain too tight.
    No one ever became unsuccessful by helping others out

  7. #7
    Avoid using vitamin E on your scar. While it may help cosmetically, it actually weakens the collagen, which is the strongest part of the scar. Avoid using too much lotion on the area, but also don't let it get dry and cracked. Massage is probably not a very good idea. If you are a keloid former or have mounded up scar tissue, you can consider the use of a silicone self-adhesive dressing like this, which should be applied over the scar, removed once daily to clean the skin, and replaced.

    https://www.performancehealth.com/sa...cone-gel-sheet

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #8
    Quote Originally Posted by SCI-Nurse View Post
    Avoid using vitamin E on your scar. While it may help cosmetically, it actually weakens the collagen, which is the strongest part of the scar. Avoid using too much lotion on the area, but also don't let it get dry and cracked. Massage is probably not a very good idea. If you are a keloid former or have mounded up scar tissue, you can consider the use of a silicone self-adhesive dressing like this, which should be applied over the scar, removed once daily to clean the skin, and replaced.

    https://www.performancehealth.com/sa...cone-gel-sheet

    (KLD)
    Thanks, KLD. I don't think I'm a Keloid former. Yesterday, I got up in the chair at around 11am and didn't get back into bed until around 7pm. For posterity and reference, here is a picture of the area before getting up:

    https://ibb.co/fYDVLxR


    and here is the exact same area when I got back into bed at around 7pm:

    https://ibb.co/t4CycJx

    There is still a little bit of pain in the area (and it's still clearly pink), but it's definitely less painful than it has been historically, and as you can see from the pictures, I think it's holding up really good to basic sitting in the chair, as I can't really tell the difference between the pictures.

    I am wondering about getting back onto a commode for BP and shower. What's the general rule/sitting protocol? My normal routine is that I transfer directly onto the over-the-toilet commode for BP but I have a different commode in the shower which requires me to transfer onto a transfer board and scoot about a foot and a half into the shower. So what's the best approach here/what have people done in the past?

    Thanks ahead of time.
    No one ever became unsuccessful by helping others out

  9. #9
    How long are you sitting now? We required our clients to progressively sit up to 3 hours before also sitting on a well padded shower/commode chair, and time on that chair should be included in your daily sitting time allotment, with weight shifts done just as in the wheelchair ever 10-15 minutes.

    If you transfer leaning forward so that your weight on the board is on your thighs, and not on your ischiums or coccyx, you can use a slide board. Otherwise we would only allow a lift transfer.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
    Quote Originally Posted by SCI-Nurse View Post
    How long are you sitting now? We required our clients to progressively sit up to 3 hours before also sitting on a well padded shower/commode chair, and time on that chair should be included in your daily sitting time allotment, with weight shifts done just as in the wheelchair ever 10-15 minutes.

    If you transfer leaning forward so that your weight on the board is on your thighs, and not on your ischiums or coccyx, you can use a slide board. Otherwise we would only allow a lift transfer.

    (KLD)
    Thanks KLD.

    Yesterday, I was up for ~ 8 hours. Today, it was ~ 6 hours except for about 10 minutes halfway in between when I got into bed to take some more pictures.

    I guess the concern I have is that when I'm on the commode for BP, the skin right around my tailbone, where the shear wound was, will stretch and maybe damage what's healed there. I'm not sure how pliable the skin is or if there's a way to test if the skin has enough elasticity there that if I sit in the commode it won't "split" because of the opposing pulling forces from my weight in the commode. So is there a way to tell when it's ready, or is it another "bite the bullet" and see what happens scenario?

    I suppose the same concern applies to the shower commode; your recommendation re the transfer with my weight shifted forwarded makes a lot of sense.
    No one ever became unsuccessful by helping others out

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