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Kowalski G, Leppert W, Domagalska M, Grochowicka M, Teżyk A, Słowiński K, Bienert A, Szkutnik-Fiedler D, Wieczorowska-Tobis K. Analgesic Efficacy of Oxycodone in Postoperative Dressings after Surgical Treatment of Burn Wounds: A Randomised Controlled Trial. J Clin Med 2024; 13:784. [PMID: 38337478 PMCID: PMC10856020 DOI: 10.3390/jcm13030784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. MATERIAL AND METHODS Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia were included. Burn wounds were treated with dressings, to which oxycodone was added at 20 mg in Group 1 and 10 mg in Group 2. After the surgery, plasma oxycodone and noroxycodone concentrations were assayed, and pain intensity was assessed with Numerical Rating Scale (NRS). RESULTS In Group 1, no patient reported pain; in Group 2, four patients reported pain. The pain intensity, according to NRS, was 1-8. Plasma concentration of oxycodone in the blood serum was in the range of 1.24-3.15 ng/mL and 1.09-1.28 ng/mL in Group 1 and Group 2, respectively. Noroxycodone was not detected in the plasma. Adverse effects were not observed in any of the treated patients. CONCLUSIONS Oxycodone in dressings provides patients with adequate and safe analgesia.
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Affiliation(s)
- Grzegorz Kowalski
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
- Department of Anesthesiology, Józef Struś Multiprofile Municipal Hospital, 61-701 Poznań, Poland
| | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Małgorzata Domagalska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Monika Grochowicka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Artur Teżyk
- Department of Forensic Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Krzysztof Słowiński
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Agnieszka Bienert
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Danuta Szkutnik-Fiedler
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Klosko RC, Saphire ML. Topical Morphine Gel as a Systemic Opioid Sparing Technique. J Pain Palliat Care Pharmacother 2022; 36:159-165. [PMID: 35678475 DOI: 10.1080/15360288.2022.2084488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Rachel C Klosko
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA
| | - Maureen L Saphire
- Saphire Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Gutierrez Y, Pourali SP, Kucharik AH, Jones ME, Rajkumar JR, Armstrong AW. Topical opioid use in dermatologic disease: A systematic review. Dermatol Ther 2021; 34:e15150. [PMID: 34605133 DOI: 10.1111/dth.15150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/12/2023]
Abstract
Topical opioid formulations offer a potential solution to manage pain and decrease the use of systemic opioids. Synthesis of use and efficacy of topical opioids in dermatological conditions has not been well characterized. We conducted a systematic search of the PubMed, Embase, and Cochrane databases from 1980 to February 2021. This study analyzed data from 14 articles and 263 patients on the use of topical opioids for pain related to chronic ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts. Topical opioids included in this review were topical morphine and diamorphine. Common formulations consisted of 0.2-10 mg of opioid compounded with hydrogel or IntraSite gel. Topical opioids were variably effective in the use for pain control related to chronic ulcers and other dermatologic conditions. For example, the use of topical opioids appears to be effective in the reduction of pain related to pressure ulcers. Topical opioids were generally well tolerated. Insufficient data exist to adequately evaluate the efficacy and safety of topical opioid use in the context of nonpressure ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts.
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Affiliation(s)
- Yasmin Gutierrez
- School of Medicine, University of California Riverside, Riverside, California, USA
| | - Sarah P Pourali
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Alison H Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Madison E Jones
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeffrey R Rajkumar
- College of Medicine at Chicago, University of Illinois, Chicago, Illinois, USA
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Milne J, Swift A, Smith J, Martin R. Electrical stimulation for pain reduction in hard-to-heal wound healing. J Wound Care 2021; 30:568-580. [PMID: 34256596 DOI: 10.12968/jowc.2021.30.7.568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. METHOD A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. RESULTS A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. CONCLUSION As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.
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Grinblat G, Frenkel Y, Shochat I, Košec A, Midbari A, Rysin R, Dandinarasaiah M, Braverman I, Wolf Y. Myiasis in Neglected Cutaneous Squamous Cell Carcinoma of the Head and Neck: Review of Management and Current Protocol Recommendations. Adv Skin Wound Care 2021; 34:372-378. [PMID: 34125727 DOI: 10.1097/01.asw.0000752708.82300.a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To propose a first-aid management protocol for myiasis in neglected cutaneous squamous cell carcinoma (SCC) in the ED based on a recent literature review. DATA SOURCES PubMed. STUDY SELECTION Inclusion criteria were all series and case reports of primary/secondary cutaneous SCC with myiasis of the head and neck, including orbital SCC cases, published after 2005. DATA EXTRACTION A total of 14 articles including 15 patients were included. DATA SYNTHESIS Demographics, socioeconomic situation, site of the lesion, larvae species with bacterial suprainfection, and first-aid treatment options were discussed. Two representative cases are described. CONCLUSIONS Large, ulcerated, necrotic, myiasis-burdened SCC lesions in the head and neck area present a challenge for treatment, and to date, no consensus regarding first-aid management exists. The authors' proposed four-pillar first-aid management scheme may be a valid option to rapidly improve wound condition through disinfection, pain relief, and malodor and discharge eradication as a bridge to surgery.
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Affiliation(s)
- Golda Grinblat
- Golda Grinblat, MD, is Senior Consultant, Otolaryngology and Head and Neck Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel. Yulia Frenkel, MD, is Resident, Anesthesiology Department, Sheba Medical Center, Tel Aviv. Isaac Shochat, MD, is Resident, Otolaryngology and Head and Neck Surgery Department, Hillel Yaffe Medical Center. Andro Košec, MD, PhD, FEBORL-HNS, is Consultant Surgeon, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, School of Medicine, University of Zagreb, Croatia. Ayelet Midbari, MD, is Unit Chief, Pain Relief Unit, Hillel Yaffe Medical Center. Roman Rysin, MD, is Pre-Resident, Plastic Surgery Department, Hillel Yaffe Medical Center. Manjunath Dandinarasaiah, MD, is Associate Professor, Karnataka Institute of Medical Sciences, Vidyanagar, Hubli, Karnataka, India. At the Hillel Yaffe Medical Center, Itzhak Braverman, MD, is Director, Otolaryngology and Head and Neck Surgery Department; and Yoram Wolf, MD, is Unit Chief, Plastic Surgery Department. Acknowledgments: The authors thank Mrs Shelly Rado, Registered Nurse of the Pain Unit at Hillel Yaffe Medical Center for her assistance in wound care. The authors have disclosed no financial relationships related to this article. Submitted June 17, 2020; accepted in revised form October 2, 2020
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Analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds. Burns 2020; 47:880-887. [PMID: 33293157 DOI: 10.1016/j.burns.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to assess the analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds. PATIENTS AND METHODS Twenty adult patients, who underwent surgical treatment of third-degree burn wounds under general anesthesia, were included. Two of the patients underwent surgery twice. During surgery, patients received 50-100 μg fentanyl every 20-30 min and, after surgery, patients received 100 mg ketoprofen twice daily. Additionally, ten patients (group 1) received 50 μg sufentanil added to the burn wound dressings soaked in octenidine and phenoxyethanol while 10 patients (group 2) received 25 μg sufentanil added to the same dressings. The rescue analgesic, which was administered when pain intensified, was 5 mg subcutaneous morphine. Plasma sufentanil concentrations were assayed at 1, 2, 3, and 6 h after surgery completion and when pain was reported, along with pain intensity evaluation. RESULTS Sufentanil was not detected in the serum of any patients. Rescue morphine was given during the postoperative period (24 h) in one patient in group 1 (who underwent surgery twice) and three patients in group 2. The mean sufentanil concentration in dressings was higher in group 1 (0.13 ± 0.03) than group 2 (0.06 ± 0.03 μg/mL; p < 0.001). The group 1 patient who received rescue morphine had a sufentanil concentration of 0.10 μg/mL, which was the lowest concentration in group 1. Group 2 patients who received rescue morphine had sufentanil concentrations of at least two-fold lower (0.03-0.05 μg/mL). No adverse effects were observed. CONCLUSIONS Sufentanil in dressings after burn wound surgery provides effective and safe analgesia and the sufentanil concentration in dressings should be ≥0.10 μg/mL in a solution of octenidine and phenoxyethanol.
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Abstract
Palliative wound care is a philosophy of wound management that prioritizes comfort over healing and attends to the emotional distress these wounds can cause. Intervention strategies focus on management of symptoms such as pain, odor, bleeding, and exudate. Historic treatments such as honey, chlorine, and vinegar have gained renewed interest, and although well suited to the palliative setting, there is an increasing amount of research exploring their efficacy in other contexts. The lived experience of patients and caregivers facing these wounds is often stressful and isolating, and any treatment plan must address these issues along with the physical aspects of care.
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Improved Morphine-Loaded Hydrogels for Wound-Related Pain Relief. Pharmaceutics 2019; 11:pharmaceutics11020076. [PMID: 30759886 PMCID: PMC6409998 DOI: 10.3390/pharmaceutics11020076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/29/2022] Open
Abstract
The use of morphine applied topically to painful wounds has potential advantages, such as dose reduction, fewer side effects and compound formulations, have been proposed for this purpose. Given the potential high impact of drug product quality on a patient’s health, the aim of the present study was to develop two stable sterile hydrogels containing morphine hydrochloride, intended for topical application on painful wounds. Two carboxymethylcellulose sodium-based hydrogels were prepared containing 0.125% w/w (F1-MH semi-solid formulation) and 1.0% w/w (F2-MH fluid formulation) morphine hydrochloride (MH), respectively. Studies included a risk assessment approach for definition of the quality target product profile (QTPP) and assessment of critical quality attributes (CQA) of the hydrogels to support product quality and safety. Safe, odourless, yellowish, translucent and homogeneous gels were obtained, with suitable microbiological and pharmaceutical characteristics. The active substance concentration was adapted according to the characteristics of the dose-metering device. Release profiles were investigated using Franz diffusion cells, and characterised by different kinetic models. Increasing gel viscosity prolonged drug release, with rates of 17.9 ± 2.2 μg·cm−2·h−1 (F1-MH) and 258.0 ± 30.4 μg·cm−2·h−1 (F2-MH), allowing for the reduction of the number of applications and improving patient compliance. The gels proved to be stable for up to 60 days at room temperature. The semi-solid and fluid MH-containing hydrogel formulations are safe, stable and suitable for use in hospital settings, which is rather important for wound-related pain management in cancer palliative care or burn patients.
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Maida V, Corban J. Topical Medical Cannabis: A New Treatment for Wound Pain-Three Cases of Pyoderma Gangrenosum. J Pain Symptom Manage 2017; 54:732-736. [PMID: 28818631 DOI: 10.1016/j.jpainsymman.2017.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/26/2017] [Accepted: 06/01/2017] [Indexed: 12/20/2022]
Abstract
Pain associated with integumentary wounds is highly prevalent, yet it remains an area of significant unmet need within health care. Currently, systemically administered opioids are the mainstay of treatment. However, recent publications are casting opioids in a negative light given their high side effect profile, inhibition of wound healing, and association with accidental overdose, incidents that are frequently fatal. Thus, novel analgesic strategies for wound-related pain need to be investigated. The ideal methods of pain relief for wound patients are modalities that are topical, lack systemic side effects, noninvasive, self-administered, and display rapid onset of analgesia. Extracts derived from the cannabis plant have been applied to wounds for thousands of years. The discovery of the human endocannabinoid system and its dominant presence throughout the integumentary system provides a valid and logical scientific platform to consider the use of topical cannabinoids for wounds. We are reporting a prospective case series of three patients with pyoderma gangrenosum that were treated with topical medical cannabis compounded in nongenetically modified organic sunflower oil. Clinically significant analgesia that was associated with reduced opioid utilization was noted in all three cases. Topical medical cannabis has the potential to improve pain management in patients suffering from wounds of all classes.
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Affiliation(s)
- Vincent Maida
- University of Toronto, Toronto, Ontario, Canada; William Osler Health System, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.
| | - Jason Corban
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Dembla S, Behrendt M, Mohr F, Goecke C, Sondermann J, Schneider FM, Schmidt M, Stab J, Enzeroth R, Leitner MG, Nuñez-Badinez P, Schwenk J, Nürnberg B, Cohen A, Philipp SE, Greffrath W, Bünemann M, Oliver D, Zakharian E, Schmidt M, Oberwinkler J. Anti-nociceptive action of peripheral mu-opioid receptors by G-beta-gamma protein-mediated inhibition of TRPM3 channels. eLife 2017; 6:26280. [PMID: 28826482 PMCID: PMC5593507 DOI: 10.7554/elife.26280] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022] Open
Abstract
Opioids, agonists of µ-opioid receptors (µORs), are the strongest pain killers clinically available. Their action includes a strong central component, which also causes important adverse effects. However, µORs are also found on the peripheral endings of nociceptors and their activation there produces meaningful analgesia. The cellular mechanisms downstream of peripheral µORs are not well understood. Here, we show in neurons of murine dorsal root ganglia that pro-nociceptive TRPM3 channels, present in the peripheral parts of nociceptors, are strongly inhibited by µOR activation, much more than other TRP channels in the same compartment, like TRPV1 and TRPA1. Inhibition of TRPM3 channels occurs via a short signaling cascade involving Gβγ proteins, which form a complex with TRPM3. Accordingly, activation of peripheral µORs in vivo strongly attenuates TRPM3-dependent pain. Our data establish TRPM3 inhibition as important consequence of peripheral µOR activation indicating that pharmacologically antagonizing TRPM3 may be a useful analgesic strategy. There are very few treatments available for people suffering from strong or long-lasting pain. Currently, substances called opioids – which include the well-known drug morphine – are the strongest painkillers. However, these drugs also cause harmful side effects, which makes them less useful. Like all drugs, opioids mediate their effects by interacting with molecules in the body. In the case of opioids, these interacting molecules belong to a group of receptor proteins called G-protein coupled receptors (or GPCRs for short). These opioid receptors are widely distributed in the nerve cells and brain regions that detect and transmit pain signals. It was poorly understood how activation of opioid receptors reduces the activity of pain-sensing nerve cells, however several lines of evidence had suggested that a protein called TRPM3 might be involved. TRPM3 is a channel protein that allows sodium and calcium ions to enter into nerve cells by forming pores in cell membranes, and mice that lack this protein are less sensitive to certain kinds of pain. Dembla, Behrendt et al. now show that activating opioid receptors on nerve cells from mice, with morphine and a similar substance, rapidly reduces the flow of calcium ions through TRPM3 channels. Further experiments confirmed that activating opioid receptors in a mouse’s paw also reduced the pain caused when TRPM3 proteins are activated. GPCRs interact with a group of small proteins called G-proteins that, when activated by the receptor, split into two subunits. Based on studies with human kidney cells, Dembla, Behrendt et al. found the so-called G-beta-gamma subunit then carries the signal from the opioid receptor to TRPM3. Two independent studies by Quallo et al. and Badheka, Yudin et al. also report similar findings. These new findings show that drugs already used in the treatment of pain can indirectly alter how TRPM3 works in a dramatic way. These results might help scientists to find drugs that work in a more direct way to dial down the activity of TRPM3 and to combat pain with fewer side effects. Though first it will be important to confirm these new findings in human nerve cells.
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Affiliation(s)
- Sandeep Dembla
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Marc Behrendt
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Florian Mohr
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Christian Goecke
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Julia Sondermann
- Max-Planck-Institut für Experimentelle Medizin, Göttingen, Germany
| | - Franziska M Schneider
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Marlene Schmidt
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Julia Stab
- Experimentelle und Klinische Pharmakologie und Toxikologie, Universität des Saarlandes, Homburg, Germany
| | - Raissa Enzeroth
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Michael G Leitner
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Paulina Nuñez-Badinez
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim Heidelberg University, Mannheim, Germany
| | - Jochen Schwenk
- Institute of Physiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Nürnberg
- Abteilung für Pharmakologie und Experimentelle Therapie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Universität Tübingen, Tübingen, Germany
| | - Alejandro Cohen
- Proteomics and Mass Spectrometry Core Facility, Life Sciences Research Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephan E Philipp
- Experimentelle und Klinische Pharmakologie und Toxikologie, Universität des Saarlandes, Homburg, Germany
| | - Wolfgang Greffrath
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim Heidelberg University, Mannheim, Germany
| | - Moritz Bünemann
- Institut für Pharmakologie und Klinische Pharmazie, Philipps-Universität Marburg, Marburg, Germany
| | - Dominik Oliver
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
| | - Eleonora Zakharian
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, United States
| | - Manuela Schmidt
- Max-Planck-Institut für Experimentelle Medizin, Göttingen, Germany
| | - Johannes Oberwinkler
- Institut für Physiologie und Pathophysiologie, Philipps-Universität Marburg, Marburg, Germany
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Topical application of morphine for wound healing and analgesia in patients with oral lichen planus: a randomized, double-blind, placebo-controlled study. Clin Oral Investig 2017; 22:305-311. [PMID: 28353022 DOI: 10.1007/s00784-017-2112-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of topical morphine on erosive/ulcerative lesions in patients with oral lichen planus (OLP). Previous studies reported on an enhanced remission of skin wounds when morphine was applied topically. MATERIALS AND METHODS This was single-center, prospective, double-blind, placebo-controlled, randomized, multi-arm (3), phase II study (RCT). Patients diagnosed with erosive and/or ulcerative OLP applied 0.2 or 0.4 mg morphine dissolved in glycerine, three times a day for 5 days. The primary outcome was the extent of healing. Secondary outcomes were as follows: (1) effect on pain, (2) presence and severity of opioid-related central and local side effects, (3) whether patients required 'rescue medication' for treatment of pain, and (4) total intake of test substance. RESULTS A total of 123 patients were screened for eligibility, 45 patients were recruited into the study, and 43 completed it. Patients applied a solution of either placebo or 0.2 or 0.4% morphine in groups of n = 12, n = 15, and n = 16, respectively. Extent of healing was similar in the three groups. Severity of pain was minor pre-treatment and throughout the course of the study. Only minor adverse events were reported (dry mouth, burning sensation). CONCLUSION Morphine did not enhance wound healing compared to placebo-treated patients. Healing was observed in all groups, which may be attributed to an effect of glycerine or to the natural course of the disease. Patients experienced only mild levels of pain, rendering the model insensitive for assessing pain. CLINICAL RELEVANCE OLP is a chronic disease and current treatment options are limited. Healing occurred in all three study groups, an effect we attribute to the carrier.
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Clinical concentrations of morphine are cytotoxic on proliferating human fibroblasts in vitro. Eur J Anaesthesiol 2016; 33:832-839. [DOI: 10.1097/eja.0000000000000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Finch PM, Drummond PD. Topical treatment in pain medicine: from ancient remedies to modern usage. Pain Manag 2015. [DOI: 10.2217/pmt.15.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Over several millennia, substances have been applied to the skin for treatment of pain. Some ingredients are in current use; others have been discontinued. Mechanisms of action include interactions with nociceptive neural networks and inflammatory processes. Substances must penetrate the stratum corneum barrier and vehicles that enhance penetration have been developed. Topical drugs with links to the past include menthol, capsaicin, some opioids, local anesthetic agents and NSAIDs. Mandragora is also described as an example of a herbal remedy that has been discontinued due to its toxicity. The future for topical drugs is promising, with the advent of new drugs tailored for specific pain mechanisms and the development of both penetration enhancers and sterile preparation methods.
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Affiliation(s)
- Philip M Finch
- Perth Pain Management Centre, Perth, Western Australia, Australia
| | - Peter D Drummond
- Centre for Research on Chronic Pain & Inflammatory Diseases, Murdoch University, Perth, Western Australia, Australia
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GUPTA M, POONAWALA T, FAROOQUI M, ERICSON ME, GUPTA K. Topical fentanyl stimulates healing of ischemic wounds in diabetic rats. J Diabetes 2015; 7:573-583. [PMID: 25266258 PMCID: PMC4844062 DOI: 10.1111/1753-0407.12223] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/05/2014] [Accepted: 09/21/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Topically applied opioids promote angiogenesis and healing of ischemic wounds in rats. We examined if topical fentanyl stimulates wound healing in diabetic rats by stimulating growth-promoting signaling, angiogenesis, lymphangiogenesis and nerve regeneration. METHODS We used Zucker diabetic fatty rats that develop obesity and diabetes on a high fat diet due to a mutation in the Leptin receptor. Fentanyl blended with hydrocream was applied topically on ischemic wounds twice daily, and wound closure was analyzed regularly. Wound histology was analyzed by hematoxylin and eosin staining. Angiogenesis, lymphangiogenesis, nerve fibers and phospho-platelet derived growth factor receptor-β (PDGFR-β) were visualized by CD31-, lymphatic vessel endothelium-1, protein gene product 9.5- and anti-phospho PDGFR-β-immunoreactivity, respectively. Nitric oxide synthase (NOS) and PDGFR-β signaling were analyzed using Western immunoblotting. RESULTS Fentanyl significantly promoted wound closure as compared to phosphate-buffered saline (PBS). Histology scores were significantly higher in fentanyl-treated wounds, indicative of increased granulation tissue formation, reduced edema and inflammation, and increased matrix deposition. Fentanyl treatment resulted in increased wound angiogenesis, lymphatic vasculature, nerve fibers, nitric oxide, NOS and PDGFR-β signaling as compared to PBS. Phospho-PDGFR-β co-localized with CD31 co-staining for vasculature. CONCLUSIONS Topically applied fentanyl promotes closure of ischemic wounds in diabetic rats. Increased angiogenesis, lymphangiogenesis, peripheral nerve regeneration, NO and PDGFR-β signaling are associated with fentanyl-induced tissue remodeling and wound healing.
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Affiliation(s)
- Mihir GUPTA
- Stanford University School of Medicine, Stanford, CA, 94305
| | - Tasneem POONAWALA
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, Minneapolis, MN 55455
| | - Mariya FAROOQUI
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, Minneapolis, MN 55455
| | - Marna E ERICSON
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN 55455
| | - Kalpna GUPTA
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, Minneapolis, MN 55455
- Corresponding Author: Kalpna Gupta, Ph.D., Vascular Biology Center, Medicine - Hematology, Oncology and Transplantation, University of Minnesota, Mayo Mail Code 480; 420 Delaware Street SE, Minneapolis, MN, 55455, USA, Phone: 612-625-7648, Fax: 612-625-6919,
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Musazzi UM, Matera C, Dallanoce C, Vacondio F, De Amici M, Vistoli G, Cilurzo F, Minghetti P. On the selection of an opioid for local skin analgesia: Structure-skin permeability relationships. Int J Pharm 2015; 489:177-85. [PMID: 25934430 DOI: 10.1016/j.ijpharm.2015.04.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/21/2015] [Accepted: 04/25/2015] [Indexed: 11/26/2022]
Abstract
Recent studies demonstrated that post-herpetical and inflammatory pain can be locally managed by morphine gels, empirically chosen. Aiming to rationalize the selection of the most suitable opioid for the cutaneous delivery, we studied the in vitro penetration through human epidermis of eight opioids, evidencing the critical modifications of the morphinan core. Log P, log D, solid-state features and solubility were determined. Docking simulations were performed using supramolecular assembly made of ceramide VI. The modifications on position 3 of the morphinan core resulted the most relevant in determining both physicochemical characteristics and diffusion pattern. The 3-methoxy group weakened the cohesiveness of the crystal lattice structure and increased the permeation flux (J). Computational studies emphasized that, while permeation is essentially controlled by molecule apolarity, skin retention depends on a fine balance of polar and apolar molecular features. Moreover, ChemPLP scoring the interactions between the opioids and ceramide, correlated with both the amount retained into the epidermis (Qret) and J. The balance of the skin penetration properties and the affinity potency for μ-receptors evidenced hydromorphone as the most suitable compound for the induction of local analgesia.
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Affiliation(s)
- Umberto M Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
| | - Carlo Matera
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
| | - Clelia Dallanoce
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
| | - Federica Vacondio
- Department of Pharmacy, Università degli Studi di Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Marco De Amici
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
| | - Giulio Vistoli
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
| | - Francesco Cilurzo
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy.
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy
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17
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Morphine for the treatment of pain in sickle cell disease. ScientificWorldJournal 2015; 2015:540154. [PMID: 25654130 PMCID: PMC4306369 DOI: 10.1155/2015/540154] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/18/2014] [Indexed: 01/11/2023] Open
Abstract
Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. Experimental and clinical studies, even though extremely few, suggest that opioids may exacerbate existent organ damage and also stimulate pathologies of their own. Because of the recurrent and/or chronic use of large doses of opioids in SCD, it is critical to evaluate the role and contribution of opioids in many complications of SCD. The aim of this review is to initiate inquiry to develop strategies that may prevent the inadvertent effect of opioids on organ function in SCD, should it occur, without compromising analgesia.
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18
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Zaslansky R, Ben-Nun O, Ben-Shitrit S, Ullmann Y, Kopf A, Stein C. A randomized, controlled, clinical pilot study assessing the analgesic effect of morphine applied topically onto split-thickness skin wounds. ACTA ACUST UNITED AC 2014; 66:1559-66. [PMID: 24942055 DOI: 10.1111/jphp.12284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of an opioid administered topically onto a standardized skin wound in patients without significant comorbidity. Findings to date are contradictory, often obtained from multimorbid patients with wounds lacking uniformity. METHODS Forty-four patients undergoing surgery for skin grafting were randomly assigned to receive morphine (0.25, 0.75 or 1.25 mg/100 cm(2) wound size) in hydroxyethylcellulose gel or placebo applied onto the excised split-thickness donor wound at the end of surgery. Pain, supplementary systemic opioids and adverse effects were assessed during the first 24 h after application. Healing was examined when the dressings were removed. KEY FINDINGS Morphine doses ranged from 0.25 to 5.4 mg (mean 1.93 ± standard deviation 1.34 mg). No differences in pain scores or use of supplementary analgesics were found between the groups. Serious adverse effects did not occur; healing was not impaired. Large intragroup variability was observed for pain scores, wound sizes and supplementary analgesia. CONCLUSIONS Patients treated with topically applied morphine gel onto standardized skin wounds did not report lower pain scores compared with placebo-treated patients. Larger groups would be required to arrive at definitive conclusions. The split-thickness skin graft model can be used for future research.
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Affiliation(s)
- Ruth Zaslansky
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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19
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Stein C. Targeting pain and inflammation by peripherally acting opioids. Front Pharmacol 2013; 4:123. [PMID: 24068999 PMCID: PMC3779927 DOI: 10.3389/fphar.2013.00123] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/05/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christoph Stein
- Department of Anesthesiology and Critical Care Medicine, Charité Campus Benjamin Franklin Freie Universitaet Berlin Berlin, Germany
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20
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21
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McCuaig CC, Cohen L, Powell J, Hatami A, Marcoux D, Maari C, Caouette-Laberge L, Bortoluzzi P, Ondrejchak S, Dubois J. Therapy of Ulcerated Hemangiomas. J Cutan Med Surg 2013; 17:233-42. [DOI: 10.2310/7750.2012.12037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Cutaneous ulceration is the most common complication of infantile hemangiomas (IHs) seen in a pediatric dermatology practice. Objective: The most effective treatments in our experience are compared to those in the current literature. Methods: The study was a retrospective chart review of therapy of 169 ulcerated IHs at a tertiary care pediatric hospital and a literature review. Results: Combination therapy was the rule. Local wound care was required in all, pain management in 72%, pulsed dye laser in 42%, infection control in 38%, diminution of the hemangioma through systemic therapy in 36%, and suppression of bleeding in 2%. Limitations: A retrospective review compared to a case-control study has inherent bias. In addition, our cases were all at a tertiary referral center. Conclusion: All ulcerated IHs benefit from local barrier creams or dressings. Pulsed dye laser, antibiotics, topical morphine 0.1% in hydrogel, topical becaplermin, and, most importantly, systemic therapy (especially propranolol) to reduce the hemangioma may be useful.
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Affiliation(s)
- Catherine C. McCuaig
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Lynn Cohen
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Julie Powell
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Afshin Hatami
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Danielle Marcoux
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Catherine Maari
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Louise Caouette-Laberge
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Patricia Bortoluzzi
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Sandra Ondrejchak
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
| | - Josée Dubois
- From the Department of Family Medicine, McGill University; and Division of Pediatric Dermatology, Department of Pediatrics; and Division of Plastic Surgery, Department of Surgery; and Department of Interventional Radiology, CHU Sainte Justine, University of Montreal, Montreal, QC
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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; 154:1920-1928. [PMID: 23778297 DOI: 10.1016/j.pain.2013.06.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Tanya Graham
- King's College London, London, UK Zurich University of Applied Sciences, Zurich, Switzerland Guys and St Thomas's NHS Foundation Trust, London, UK National University of Ireland, Galway, Ireland
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Stein C, Küchler S. Targeting inflammation and wound healing by opioids. Trends Pharmacol Sci 2013; 34:303-12. [PMID: 23602130 DOI: 10.1016/j.tips.2013.03.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
Abstract
Opioid receptors are expressed on peripheral sensory nerve endings, cutaneous cells, and immune cells; and local application of opioids is used for the treatment of inflammatory pain in arthritis, burns, skin grafts, and chronic wounds. However, peripherally active opioids can also directly modulate the inflammatory process and wound healing. Here, we discuss the underlying mechanisms of opioid action and the conceivable therapeutic approaches for opioid treatment, as investigated in experimental and clinical studies. A large number of in vitro experiments and animal model investigations have produced evidence that peripherally active opioids can reduce plasma extravasation, vasodilation, proinflammatory neuropeptides, immune mediators, and tissue destruction. In contrast to currently available anti-inflammatory agents, opioids have not demonstrated organ toxicity, thus making them interesting candidates for drug development. Few clinical studies have tapped into this potential to date.
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Affiliation(s)
- Christoph Stein
- Department of Anesthesiology and Critical Care Medicine, Freie Universität Berlin, 12200 Berlin, Germany.
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24
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Opioids, sensory systems and chronic pain. Eur J Pharmacol 2013; 716:179-87. [PMID: 23500206 DOI: 10.1016/j.ejphar.2013.01.076] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/11/2012] [Accepted: 01/09/2013] [Indexed: 11/20/2022]
Abstract
Opioids are the oldest and most potent drugs for the treatment of severe pain. Their clinical application is undisputed in acute pain (e.g. associated with trauma or surgery) but their long-term use in chronic pain has met increasing scrutiny. Therefore, this article will review sensory mechanisms related to opioid analgesia and side effects with a special emphasis on chronic pain. Central and peripheral sites of analgesic actions and side effects, as well as conventional and novel opioid compounds will be discussed. Since pain is a complex bio-psycho-social phenomenon, non-pharmacological considerations important for the understanding of opioid analgesic efficacy are also included. Finally, examples of challenging clinical situations such as the perioperative management of patients receiving long-term opioid treatment are illustrated.
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Heilmann S, Küchler S, Wischke C, Lendlein A, Stein C, Schäfer-Korting M. A thermosensitive morphine-containing hydrogel for the treatment of large-scale skin wounds. Int J Pharm 2013; 444:96-102. [PMID: 23352858 DOI: 10.1016/j.ijpharm.2013.01.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/11/2013] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Topically applied opioids are an option to induce efficient analgesia in patients with severe skin wounds. For ongoing pain reduction, the vehicle should provide sustained drug release in order to increase the intervals during the regular wound dressing changes. In addition, the formulation should not impair wound healing. Hydrogels provide a moist wound environment, which is known to facilitate the healing process. METHODS AND RESULTS Investigating poloxamer hydrogels as a carrier system for morphine in terms of release behavior and (per-)cutaneous absorption, poloxamer 407 25wt.% hydrogel sustained morphine release up to 24h. The drug release rate decreased with increasing concentration of the gel forming triblock copolymer. Poloxamer 407 25wt.% hydrogel retarded morphine uptake into reconstructed human skin and percutaneous drug absorption compared to a hydroxyethyl cellulose reference gel. CONCLUSIONS The results of our in vitro study indicate that the thermosensitive poloxamer 407 25wt.% hydrogel is an appropriate carrier system for the topical application of morphine with regard to sustained drug release and ongoing analgesia.
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Affiliation(s)
- Sarah Heilmann
- Institute for Pharmacy, Freie Universität Berlin, Berlin, Germany
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26
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Heilmann S, Küchler S, Schäfer-Korting M. Morphine Metabolism in Human Skin Microsomes. Skin Pharmacol Physiol 2012; 25:319-22. [DOI: 10.1159/000342067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/19/2012] [Indexed: 02/04/2023]
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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 2011; 9:419-27. [PMID: 22151619 DOI: 10.1111/j.1742-481x.2011.00901.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic painful wounds, a major health problem, have a detrimental impact on the quality of life due to associated pain. Some clinical reports have suggested that local administration of morphine could be beneficial. The aim of this study was to evaluate the analgesic effect of topically applied morphine on chronic painful leg ulcers. Twenty-one patients were randomly assigned to receive either morphine or placebo in a randomised, placebo-controlled, crossover pilot study. Each patient was treated four times in total. Pain was measured by the visual analogue score (VAS) before application of gel, directly after and after 2, 6, 12 and 24 hours. Although an overall, clinically relevant, reduction of pain was observed upon treatment with morphine, the difference was not statistically significant. Morphine reduced pain scores more than placebo on treatment occasions 1 and 2. The difference was statistically significant only 2 hours after dressing on the first treatment occasion. Thus, our study did not demonstrate a consistent and globally significant difference in nociception in patients treated with morphine. However, the relatively small number of patients included in our study and other methodological limitations makes it difficult for us to draw general conclusions regarding efficacy of topically applied morphine as an effective treatment for some painful ulcers. Further studies are warranted to evaluate the value of topically applied morphine in the treatment of patients with chronic painful leg ulcers.
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Affiliation(s)
- Salumeh Bastami
- Department of Medical and Health Sciences, Division of Drug Research/Clinical Pharmacology, Linköping University, Linköping, Sweden.
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