Should topical opioid analgesics be regarded as effective and safe when applied to chronic cutaneous lesions?

Peter Farley

Research output: Contribution to journalArticle

Abstract

Objectives: The induction of analgesia for many chronic cutaneous lesions requires treatment with an opioid analgesic. In many patients suffering with these wounds such drugs are either contraindicated or shunned because of their association with death. There are now case reports involving over 100 patients with many different types of chronic superficial wounds, which suggest that the topical application of an opioid in a suitable gel leads to a significant reduction in the level of perceived pain.

Key findings: Some work has been undertaken to elucidate the mechanisms by which such a reduction is achieved. To date there have been no proven deleterious effects of such an analgesic system upon wound healing. Although morphine is not absorbed through the intact epidermis, an open wound provides no such barrier and for large wounds drug absorption can be problematic. However, for most chronic cutaneous lesions, where data has been gathered, the blood levels of the drug applied ranges from undetectable to below that required for a systemic effect.

Summary If proven, the use of opioids in this way would provide adequate analgesia for a collection of wounds, which are difficult to treat in patients who are often vulnerable. Proof of this concept is now urgently required.

Original languageEnglish
Pages (from-to)747-756
Number of pages10
JournalJournal of Pharmacy and Pharmacology
Volume63
Issue number6
Early online date3 May 2011
DOIs
Publication statusPublished - Jun 2011

Fingerprint

Opioid Analgesics
Skin
Wounds and Injuries
Analgesia
Pharmaceutical Preparations
Epidermis
Wound Healing
Morphine
Analgesics
Gels
Pain
Therapeutics

Keywords

  • analgesia
  • cutaneous lesions
  • healing
  • morphine
  • topical opioid

Cite this

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abstract = "Objectives: The induction of analgesia for many chronic cutaneous lesions requires treatment with an opioid analgesic. In many patients suffering with these wounds such drugs are either contraindicated or shunned because of their association with death. There are now case reports involving over 100 patients with many different types of chronic superficial wounds, which suggest that the topical application of an opioid in a suitable gel leads to a significant reduction in the level of perceived pain. Key findings: Some work has been undertaken to elucidate the mechanisms by which such a reduction is achieved. To date there have been no proven deleterious effects of such an analgesic system upon wound healing. Although morphine is not absorbed through the intact epidermis, an open wound provides no such barrier and for large wounds drug absorption can be problematic. However, for most chronic cutaneous lesions, where data has been gathered, the blood levels of the drug applied ranges from undetectable to below that required for a systemic effect. Summary If proven, the use of opioids in this way would provide adequate analgesia for a collection of wounds, which are difficult to treat in patients who are often vulnerable. Proof of this concept is now urgently required.",
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Should topical opioid analgesics be regarded as effective and safe when applied to chronic cutaneous lesions? / Farley, Peter.

In: Journal of Pharmacy and Pharmacology, Vol. 63, No. 6, 06.2011, p. 747-756.

Research output: Contribution to journalArticle

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