Topical Morphine Gel as a Systemic Opioid Sparing Technique

Use of topical morphine gel was explored retrospectively for treatment of painful chronic wounds in hospitalized adults. Systemic opioid use and pain intensity were characterized before and after morphine gel initiation using morphine equivalent daily dose (MEDD) and the Defense and Veterans Pain Rating Scale (DVPRS) score at 24 hours before compared to 24 hours, 48 hours, and one week after morphine gel initiation. Twenty-three patients received 371 applications of topical morphine gel. The median number of applications received was 8.0 [5.0 to 26.0] per patient. Median change in MEDD 24 hours after morphine gel initiation was 0.0 mg [-15.3 to 11.3] (n = 21), 48 hours after was -4.4 mg [-27.5 to 8.8] (n = 20), and one week after was -7.5 mg [-41.9 to -0.3] (n = 12). Median change in DVPRS score 24 hours after morphine gel initiation was 0.0 [-0.5 to 1.5] (n = 13), 48 hours after was -0.5 [-3.25 to 0.0] (n = 14), and one week after was 1.0 [-1.0 to 3.5] (n = 9). In this single-center analysis, patients with painful chronic wounds treated with morphine gel required lower doses of systemic opioids. Topical morphine gel may provide analgesia while sparing systemic opioid use.