MORPHINE GEL FOR PAINFUL ULCERS: A CASE REPORT
Gabilondo Zelaia I., Mora Atorrasagasti O., Urrutia Losada A., López de Torre Querejazu A., Corcóstegui Santiago B., Lertxundi Etxebarria U. Galdakao – Usansolo Hospital, Galdakao, Spain
E-mail: itxasnegabilondo@redfarma.org
Background: The local analgesic effect of topical morphine is well known since opioid receptors were found on peripheral nerve terminals. The local application has the potential advantage of
avoiding systemic adverse effects without losing analgesic efficacy. Terminal patients with cancer suffer from painful ulcers. The control of this pain commonly results to be difficult even using systemic opioids. In this context the use of topical morphine can turn out to be a good alternative. We describe the case of a woman whose painful ulcer was treated with morphine gel 0,125%.
Methods: T.M.P., a 78-year-old woman, was diagnosed with vulvar cancer (pT1b N1) which required surgical intervention and radiotherapy. A year later, in january of 2007, as a complication she developed an important ulcer in the genital area. In july, the Pharmacy was asked for a topical morphine gel for the palliative care because the pain was poorly controlled with systemic opioids. We found enough evidence to support its use in the literature.
Results: The mixture was prepared by mixing 100 mg of morphine sulphate and 80 g of Intrasite gel® (carboximethylcellulosae hidrogel) assigning a 28 day stability at room temperature as it was described in the literature. T.M.P’s ulcer was treated with it but efficacy could not be assessed because the patient died before pain evaluation.
Conclusion: Our pilot experience suggests that topically applied morphine can represent a valid alternative to relieve intractable ulcer pain.
Reference: 13th EAHP Congress, Maastricht, the Netherlands, 27-29 February 2008
Gabilondo Zelaia I., Mora Atorrasagasti O., Urrutia Losada A., López de Torre Querejazu A., Corcóstegui Santiago B., Lertxundi Etxebarria U. Galdakao – Usansolo Hospital, Galdakao, Spain
E-mail: itxasnegabilondo@redfarma.org
Background: The local analgesic effect of topical morphine is well known since opioid receptors were found on peripheral nerve terminals. The local application has the potential advantage of
avoiding systemic adverse effects without losing analgesic efficacy. Terminal patients with cancer suffer from painful ulcers. The control of this pain commonly results to be difficult even using systemic opioids. In this context the use of topical morphine can turn out to be a good alternative. We describe the case of a woman whose painful ulcer was treated with morphine gel 0,125%.
Methods: T.M.P., a 78-year-old woman, was diagnosed with vulvar cancer (pT1b N1) which required surgical intervention and radiotherapy. A year later, in january of 2007, as a complication she developed an important ulcer in the genital area. In july, the Pharmacy was asked for a topical morphine gel for the palliative care because the pain was poorly controlled with systemic opioids. We found enough evidence to support its use in the literature.
Results: The mixture was prepared by mixing 100 mg of morphine sulphate and 80 g of Intrasite gel® (carboximethylcellulosae hidrogel) assigning a 28 day stability at room temperature as it was described in the literature. T.M.P’s ulcer was treated with it but efficacy could not be assessed because the patient died before pain evaluation.
Conclusion: Our pilot experience suggests that topically applied morphine can represent a valid alternative to relieve intractable ulcer pain.
Reference: 13th EAHP Congress, Maastricht, the Netherlands, 27-29 February 2008
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