Chronic Arthritis Pain Management with Topical Morphine

Abstract

Chronic pain is a major health problem in the United States affecting 50 to 75 million Americans. The extent of pain encountered with chronic disease states may impact an individual's quality of life. Morphine is the drug of choice for severe pain. The primary purpose of the study was to determine analgesic response with the use of topical morphine to control chronic pain in a series of patients with arthritis pain. The second purpose was to detect the presence of morphine in the urine following topical administration and subsequently conclude that there had been systemic absorption of the drug. Three patients were prescribed topical morphine for chronic pain and were followed over the course of several weeks. Each patient was instructed to record the date and time of the topical morphine applications. When each patient had achieved a satisfactory level of pain control a 24-hour urine collection was obtained and taken to a laboratory for analysis. All patients reported a satisfactory degree of pain relief following topical application of morphine. The urine analysis confirmed the presence of morphine in the 24-hour samples. This analysis confirms systemic absorption of the morphine across intact skin; however the results cannot be used to quantify the degree of systemic absorption. Results of the study indicate that the use of topical morphine is effective in controlling chronic pain and topical morphine is absorbed systemically in the body.

Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary

“…Although data regarding topical gel formulations of opioids is sparse, studies of topical morphine [125–127] and hydromorphone [128] have been published. Oxymorphone was tested on human skin and was found to have permeability rates that were “low unless skin permeation enhancers were included in the vehicle” [8,129].…”

Topical Analgesics

“…A recently published case series reported the potential bene fi t of "topical" morphine in the management of chronic osteoarthritis-related pain; however, since the report emphasized that morphine or its metabolites were identi fi able in the urine of treated patients, it is unclear how truly "topical" this preparation was [ 90 ] .…”

<p>Scalable in silico Simulation of Transdermal Drug Permeability: Application of BIOiSIM Platform</p>

“…In this study, the authors detected the presence of morphine (31-191 ng/mL) in the urine of three arthritis patients over time, suggesting possible contribution of systemically absorbed morphine to the observed analgesic effect. 44 More recently, Ciałkowska-Rysz et al found self-administered topical morphine to be a highly effective and safe medication for treating mucosal and skin lesions in palliative cancer patients, providing sustained pain relief for over 28 days. 41 The studies discussed above also suggest that the transdermal route is associated with a higher patient compliance as it offers evasive dosing, the possibility of self-administration, and flexibility in adjusting dosing regimen to experience rapid and long-lasting pain relief, hence the interest in accurate modeling and simulation.…”