Compounded Morphine Gel Relieves Wound Pain

DENVER – Morphine sulfate can be readily formulated into a gel for effective topical analgesia in patients with painful skin ulcers and other wounds.

All that’s necessary is for a compounding pharmacist to mix 10 mg of intravenous morphine sulfate in 8 g of IntraSite Gel, a hydrogel widely used in wound care. The morphine gel can be applied to the wound one to three times daily, according to Mary Lynn McPherson, professor and vice chair of the department of pharmacy practice and science at the University of Maryland, Baltimore.

There is very little systemic absorption of the morphine. External irritation that manifests as burning or itching is the only side effect. This therapy works despite the limited systemic absorption because there are both central and peripheral opioid receptors.

Dressing changes can be excruciating for hospice patients. Administering an oral dose of ketamine beforehand provides effective pain relief.

"We’ve been doing this frequently in our inpatient hospice unit for patients who have these horrific, horrific wounds. We’ll give them 10, 20, or even 30 mg of ketamine orally 15-20 minutes before wound care. It has made absolutely all the difference in the world. The results have been spectacular," she said at the meeting.

The oral dose consists of intravenous ketamine solution, the only form in which the drug is available. The taste is awful, so the medication should be mixed with cherry syrup, spearmint, orange juice, or another masking flavor.

Dr. McPherson reported having no financial conflicts.

DENVER – Morphine sulfate can be readily formulated into a gel for effective topical analgesia in patients with painful skin ulcers and other wounds.

All that’s necessary is for a compounding pharmacist to mix 10 mg of intravenous morphine sulfate in 8 g of IntraSite Gel, a hydrogel widely used in wound care. The morphine gel can be applied to the wound one to three times daily, according to Mary Lynn McPherson, professor and vice chair of the department of pharmacy practice and science at the University of Maryland, Baltimore.

There is very little systemic absorption of the morphine. External irritation that manifests as burning or itching is the only side effect. This therapy works despite the limited systemic absorption because there are both central and peripheral opioid receptors.

Dressing changes can be excruciating for hospice patients. Administering an oral dose of ketamine beforehand provides effective pain relief.

"We’ve been doing this frequently in our inpatient hospice unit for patients who have these horrific, horrific wounds. We’ll give them 10, 20, or even 30 mg of ketamine orally 15-20 minutes before wound care. It has made absolutely all the difference in the world. The results have been spectacular," she said at the meeting.

The oral dose consists of intravenous ketamine solution, the only form in which the drug is available. The taste is awful, so the medication should be mixed with cherry syrup, spearmint, orange juice, or another masking flavor.

Dr. McPherson reported having no financial conflicts.

DENVER – Morphine sulfate can be readily formulated into a gel for effective topical analgesia in patients with painful skin ulcers and other wounds.

All that’s necessary is for a compounding pharmacist to mix 10 mg of intravenous morphine sulfate in 8 g of IntraSite Gel, a hydrogel widely used in wound care. The morphine gel can be applied to the wound one to three times daily, according to Mary Lynn McPherson, professor and vice chair of the department of pharmacy practice and science at the University of Maryland, Baltimore.

There is very little systemic absorption of the morphine. External irritation that manifests as burning or itching is the only side effect. This therapy works despite the limited systemic absorption because there are both central and peripheral opioid receptors.

Dressing changes can be excruciating for hospice patients. Administering an oral dose of ketamine beforehand provides effective pain relief.

"We’ve been doing this frequently in our inpatient hospice unit for patients who have these horrific, horrific wounds. We’ll give them 10, 20, or even 30 mg of ketamine orally 15-20 minutes before wound care. It has made absolutely all the difference in the world. The results have been spectacular," she said at the meeting.

The oral dose consists of intravenous ketamine solution, the only form in which the drug is available. The taste is awful, so the medication should be mixed with cherry syrup, spearmint, orange juice, or another masking flavor.

Dr. McPherson reported having no financial conflicts.