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Topical Morphine

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Letters

Vol. 30 No. 4 October 2005

Ignazio Cutaia, MD Irene Parrino, MD Archimede Center, Palermo, Italy Alessandra Casuccio, MD Univeristy of Palermo, Palermo, Italy doi:10.1016/j.jpainsymman.2005.08.010 Topical Morphine in the Treatment of Painful Ulcers
To the Editor: In a previous issue of the journal, Zeppetella et al. published data regarding the use of topical morphine in the treatment of painful ulcers, confirming the results of a pilot study. Topical morphine seems to be safe and efficacious in the treatment of ulcer-related pain.1,2 At the Medical Oncology Department of the University of L’Aquila, five patients with malignant or benign painful ulcers were observed recently. All were affected by metastatic cancer and were receiving opioids; none was receiving disease-oriented therapies. On admission, all patients reported pain localized to ulcers, which was no longer controlled by systemic treatment; pain scores were O 5 on a numerical rating scale (NRS). Morphine was topically applied to ulcers three times daily (morphine sulfate injection 10 mg in 8 g Intrasite gelÒ, Smith & Nephew, Agrate Brianza, Italy). The morphine dose was the same in all patients, regardless of the ulcer size and the scheduled systemic treatment. Ulcers were washed before treatment with a ringer lactate and metronidazole solution. Systemic treatment was not modified. Pain was assessed daily by the patients using the NRS; nurses reported local and/or systemic adverse effects related to treatment in nursing charts. Patients were observed in the hospital for seven days. Characteristics of patients and pain scores are reported in Table 1. All patients responded

References
1. National Institutes of Health NIDDK/DKUHD: Excerpts from the United States renal data system 2001. Annual data report. Am J Kidney Dis 2001; 38(Suppl 3). 2. Poppel DM, Cohen LM, Germain MJ. The

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