Topical Morphine – An Experimental Approach to Chronic Pain

Practitioners who treat patients with chronic pain understand just how difficult management of that population can be. As of today, the evaluation of pain remains completely subjective; no lab tests or imaging studies can provide any meaningful insight into how much pain a patient feels. When the pain is severe and intractable, the only option becomes opioid analgesics, which have high potential for abuse and are laden with side effects ranging from constipation and sedation to respiratory depression, testosterone deficiency, and immuno-modulation. The trouble with opioids is that they must be ingested in an oral form with systemic absorption regardless of where the actual pain lies. Over the past few years, a quiet murmur has been rippling through the pain practitioner community about the possibility of dispensing morphine as a topical agent. Small scale clinical trials and animal models have shown some promise, and also raised some questions about this experimental approach.