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ISSN: 1734-1922
Archives of Medical Science
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vol. 15
Clinical research

Topical morphine for treatment of cancer-related painful mucosal and cutaneous lesions: a double-blind, placebo-controlled cross-over clinical trial

Aleksandra Ciałkowska-Rysz, Tomasz Dzierżanowski

Arch Med Sci 2019; 15, 1: 146–151
Online publish date: 2018/01/02
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Painful mucosal and cutaneous lesions are often less responsive or even refractory to systemic opioid analgesics. There is evidence suggesting that the effectiveness of topical morphine be restricted to inflammatory pain. The studied groups were small and the observation period relatively short. The aim of this study was to assess the effectiveness and safety of topical morphine for pain related to mucosal lesions and skin ulcers.

Material and methods
The study was a 14-day randomized placebo-controlled cross-over trial (RCT) with a 28-day follow-up open phase (OP). The trial was conducted in adult patients with localized cancer-related pain and treated with systemic opioids in an oncology center or home hospice. The patients administered 0.2% gel on the mucosal lesion or 0.2% ointment on the skin lesion by themselves, without restrictions regarding the number of doses per day. The primary measurements were mean pain intensity (MPI) and mean pain relief (MPR) on the numeric rating scale (NRS 0–10), and ITT analysis was performed.

Thirty-five patients were randomized to the RCT, and all of them completed 14-day observation. The MPI before the treatment was NRS 5.9 and decreased to 2.5 after morphine (p < 0.0001 vs. placebo). The MPR was 57% after morphine, and 77% of the patients using topical morphine obtained clinically significant (at least 50% of the starting value) pain relief, statistically different from placebo. The analgesic effect was sustained over the 28-day OP period (p = 0.00001). There were only 2 cases of moderate pruritus, and no other side effects were reported.

Topical morphine was found to be a fast acting, highly effective, and safe medication for mucosal and skin lesions in palliative patients, with a sustainable pain relief effect over the 28-day observation period.


topical morphine, cancer pain, mucosal lesions, cutaneous lesions

Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993; 76: 182-91.
Bigliardi PL, Bigliardi-Qi M, Buechner S, Rufli T. Expression of mu-opiate receptor in human epidermis and keratinocytes. J Invest Dermatol 1998; 111: 297-301.
Graham T, Grocott P, Probst S, Wanklyn S, Dawson J, Gethin G. How are topical opioids used to manage painful cutaneous lesions in palliative care? A critical review. Pain 2013; 154: 1920-8.
Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995; 332: 1685-90.
Welling A. A randomised controlled trial to test the analgesic efficacy of topical morphine on minor superficial and partial thickness burns in accident and emergency departments. Emerg Med J 2007; 24: 408-12.
Draxler J, Schuch M, Paul A, et al. Topical application of morphine and buprenorphine gel has no effect in the sunburn model [German]. Schmerz 2008; 22: 571-4.
Mercadante S, Portenoy RK. Opioid poorly-responsive cancer pain. Part 1: clinical considerations. J Pain Symptom Manage 2001; 21: 144-50.
Bastami S, Frödin T, Ahlner J, Uppugunduri S. Topical morphine gel in the treatment of painful leg ulcers, a double-blind, placebo-controlled clinical trial: a pilot study. Int Wound J 2012; 9: 419-27.
Vayne-Bossert P, Escher M, de Vautibault CG, et al. Effect of topical morphine (mouthwash) on oral pain due to chemotherapy- and/or radiotherapy-induced mucositis: a randomized double-blinded study. J Palliat Med 2010; 13: 125-8.
Samczewska G, Kołodziejska J, Ciałkowska-Rysz A, Piechota-Urbańska M. The effect of cross-linking base on the properties of hydrogels with Carbopol and on pharmaceutical availability of morphine sulphate. Arch Med Sci 2007; 3: 19-26.
Zeppetella G, Paul J, Ribeiro MD. Analgesic efficacy of morphine applied topically to painful ulcers. J Pain Symptom Manage 2003; 25: 555-8.
Zeppetella G, Ribeiro MD. Morphine in intrasite gel applied topically to painful ulcers. J Pain Symptom Manage 2005; 29: 118-9.
Flock P, Gibbs L, Sykes N. Diamorphine-metronidazole gel effective for treatment of painful infected leg ulcers. J Pain Symptom Manage 2000; 20: 396-7.
Porzio G, Aielli F, Verna L, Cannita K, Marchetti P, Ficorella C. Topical morphine in the treatment of painful ulcers. J Pain Symptom Manage 2005; 30: 304-5.
Flock P. Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain. J Pain Symptom Manage 2003; 25: 547-54.
Sarvizadeh M, Hemati S, Meidani M, Ashouri M, Roayaei M, Shahsanai A. Morphine mouthwash for the management of oral mucositis in patients with head and neck cancer. Adv Biomed Res 2015; 4: 44.
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