Study to determine the efficacy of topical morphine on painful chronic skin ulcers

Vernassiere, C.; Cornet, C.; Tréchot, P.; Alla, François; Truchetet, F.; Cuny, J.-F.; Commun, N.; Brocard, Fabien; Barbaud, A.; Jl, Schmutz

doi:10.12968/jowc.2005.14.6.26793

Cited by 33 publications

(36 citation statements)

References 16 publications

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“…However, Vernassiere etal. (10) recently concluded that topical morphine, cannot be an alternative to morphine administered by other routes in painful chronic skin ulcers.…”

Section: Discussionmentioning

confidence: 99%

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Morphine Gel 0.3% Does Not Relieve Pain During Topical Photodynamic Therapy: A Randomized, Double-blind, Placebo-controlled Study

Skiveren¹,

Hædersdal²,

Philipsen³

et al. 2006

Acta Derm Venereol

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There is a demand for pain relief during photodynamic therapy. We therefore investigated the efficacy and side-effects of topical morphine gel 0.3% for pain relief during topical photodynamic therapy in a randomized, double-blind, placebo-controlled study. The study involved 28 patients with actinic keratoses or basal cell carcinomas. Each patient was treated with photodynamic therapy after superficial curettage of 2 treatment areas that were randomized to morphine gel or placebo gel. The gels were applied 15 min before illumination. Pain was assessed pre-illumination, during, and immediately after illumination, using a numeric rating scale. Skin redness was determined by reflectance spectrophotometry and the size of the treated area by protoporphyrin IX fluorescence. There were no differences between the areas according to accumulation of protoporphyrin IX (p =0.34), size of fluorescence areas (p =0.84), or skin redness (p =0.95). There was no significant pain relief of topical morphine gel compared with placebo gel (p >0.23). This negative result suggests that opioid receptors may not be involved in the pain induced by photodynamic therapy.

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“…However, Vernassiere etal. (10) recently concluded that topical morphine, cannot be an alternative to morphine administered by other routes in painful chronic skin ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…Opioid receptors have been identified in peripheral tissues and it has been suggested that topically applied opioids may have a local action (9)(10). Opioid receptors are not obvious in normal tissue, but appear within minutes to hours after the start of an inflammatory process (9,11).…”

mentioning

confidence: 99%

Morphine Gel 0.3% Does Not Relieve Pain During Topical Photodynamic Therapy: A Randomized, Double-blind, Placebo-controlled Study

Skiveren¹,

Hædersdal²,

Philipsen³

et al. 2006

Acta Derm Venereol

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“…Apesar de terem sido encontrados recetores opioides μ em nociceptores periféricos, os resultados de ensaios clínicos são desanimadores e, até à data, não foi demonstrada eficácia analgésica com esta abordagem. 41,45,46 Mais recentemente, o sevoflurano (um anestésico geral inalatório) em formulação tópica mostrou ser uma alternativa promissora para a analgesia de longa duração na UP.…”

Section: Nevralgia Pós-herpéticaunclassified

Abordagem da Dor em Dermatologia (Parte II)

Duarte

Roberto

Cruz

et al. 2018

SPDV

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RESUMO -A dor é um sintoma universal em Medicina; e na Dermatovenereologia é transversal ao seu domínio médico e cirúrgi-co. No domínio cirúrgico da especialidade temos a dor aguda peri-operatória, provavelmente mais frequente do que o esperado e cujo tratamento insuficiente implica morbilidade aguda e até potencialmente a longo prazo, dado o risco de cronificação. A dor crónica está associada a várias doenças cutâneas e é muitas vezes causa major de sofrimento para os doentes, dada a sua abordagem ser complexa, desafiante e por vezes infrutífera, agravada pela pouca evidência sobre como tratar apropriadamente o doente dermatológico com dor crónica. Este artigo é a segunda e última parte de uma revisão cujo objetivo é discutir os princípios gerais do tratamento da dor aguda peri--operatória e crónica no contexto da especialidade. Neste segundo capítulo será abordada a dor relacionada com procedimentos terapêuticos específicos. Por último, será discutida a dor crónica associada a entidades dermatológicas com quadros álgicos significativos. PALAVRAS-CHAVE - INTRODUÇÃOA dor é considerada o quinto sinal vital e o seu controlo é um indicador de qualidade dos serviços de saúde. Na primeira parte desta revisão, foi demonstrada a repercussão que a dor não controlada pode ter nas múltiplas esferas do domínio socioeconómico e familiar: sofrimento para os doentes e cuidadores, absentismo profissional, isolamento social e consumo significativo dos recursos de saúde. Observámos também que na Dermatologia e Venereologia, enquanto especialidade médico-cirúrgica, a dor não controlada é um sintoma frequentemente presente, quer por consequência de procedimentos cirúrgicos, quer devido a entidades clínicas com quadros fisiopatológicos complexos (como a úlcera de perna), e ao qual está associada uma perda major de qualidade de vida.Torna-se assim evidente a importância do tratamento eficaz da dor no doente dermatológico. Contudo, o controlo da dor, principalmente da dor crónica, continua a ser um desafio, havendo necessidade de delinear estratégias eficazes. A segunda parte deste artigo tem como objetivo colmatar esta necessidade, ao abordar o tratamento da dor aguda em procedimentos dermatológicos específicos e o tratamento da dor crónica associada a algumas entidades clínicas de gestão difícil.

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“…For example, a randomized controlled trial comparing the use of topical morphine sulfate versus traditional Jelonet dressings in burn patients revealed increased need of rescue analgesia and higher pain scores in the topical morphine group [84]. Another study revealed no significant reduction in pain with patients with skin ulcers when topical morphine was compared to placebo [85]. However, in patients with mucositis undergoing chemoradiotherapy for head and neck cancer, oral morphine mouthwash has been shown to significantly reduce pain and reduce length of functional impairment [86] In summary, topical analgesics may provide additional analgesia in patients who may not be able to tolerate the adverse effects of systemic analgesics.…”

Section: Topical Analgesicsmentioning

confidence: 99%

Acute Pain Management in the Emergency Department

Samcam¹,

Papa²

2016

Pain Management

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The most common presenting complaint to the emergency department (emergency room) is pain. Unfortunately, pain is still undertreated in this setting. Literature has shown that treatment of pain not only improves patient satisfaction but also improves mood, decreases length of hospital stay, and decreases mortality. Various pharmacological options are available for treating acute pain, ranging from oral, intravenous, and intramuscular medications; topical agents; and peripheral nerve blocks. Objectively assessing and documenting a patient's pain is the key to determining treatment. The approach to a patient with acute pain requires an experienced clinician who is aware of the pharmacology of analgesics and anesthetics, contraindications, precautions, side effects, administration methods, and monitoring requirements.This chapter briefly covers the pathophysiology of acute pain and the different treatment modalities available to the emergency physician.

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Study to determine the efficacy of topical morphine on painful chronic skin ulcers

Cited by 33 publications

References 16 publications

Morphine Gel 0.3% Does Not Relieve Pain During Topical Photodynamic Therapy: A Randomized, Double-blind, Placebo-controlled Study

Morphine Gel 0.3% Does Not Relieve Pain During Topical Photodynamic Therapy: A Randomized, Double-blind, Placebo-controlled Study

Abordagem da Dor em Dermatologia (Parte II)

Acute Pain Management in the Emergency Department

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