Recent research suggests that opioid receptors on peripheral nerve terminals may play an important role in the modulation of pain. Clinical applications of this knowledge have been rather slow to evolve. We describe a consecutive series of nine patients with painful skin ulcers due to a variety of medical conditions. All patients were treated with a topical morphine-infused gel dressing. Seven of the nine patients experienced substantial and another experienced a lesser (but still significant) degree of analgesia. The ninth reported no relief, but his wound was not an open ulcer. Discussion centers on the practical application of this development in the large number of patients with painful skin lesions.

Pain is considered the most distressing symptom of a burn wound, with analgesia usually provided via oral or parenteral medications. Use of systemic opioids can be complicated by fluctuations in bioavailability, absorption, and clearance of drugs caused by the burn. There has been little research done in the area of topical medications for burn analgesia. The following is a double-blind, placebo-controlled pilot study assessing the safety (side effects) and efficacy (pain ratings and medications administered) of morphine-infused silver sulfadiazine cream for burn pain. Four patients are reported on (2 in each group). Only participants taking placebo reported side effects related to morphine and necessitated anxiolytic medications. Pain ratings in the treatment group ranged from 0 to 7 with a mean of 2.1, whereas the placebo group's ratings ranged from 2 to 8 with a mean of 5.6. The placebo group averaged 55.3 mg oral morphine per half day, whereas the treatment group averaged 42.9 mg.

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These data show that it is unnecessary to control for menstrual cycle during insulin tolerance tests performed at 1600 hours. It is, however, necessary to control for the effect of sex on cortisol levels. Repeat testing more than one week apart does not appear to influence the glucose, ACTH or cortisol response to insulin stress.