Topical Opioids

The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. A systematic review assessed the quality of published literature and examined whether topical opioids are effective in controlling pain in palliative care settings. Eighteen studies favored topical opioids in pain relief, but time to onset and duration of analgesia varied widely, perhaps due to variances in formulations. “N-of-1 trials should be encouraged for specific clinical circumstances.”

J Pain Symptom Manage. 2009 May;37(5):913-7.
Effectiveness of topical administration of opioids in palliative care: a systematic review.
Click here to access the PubMed abstract of this article.

B&O Suppositories

B&O Suppositories are used for relief of moderate to severe pain associated with rectal or bladder spasms that may occur postoperatively or secondary to cancer. Periodically, these have been on back order. When medications are not commercially available, call our compounding pharmacy.

At Columbia- New York Presbyterian Hospital, physicians examined whether acetaminophen with codeine administered per rectum is an effective alternative for pain control compared with oral administration after an adenotonsillectomy. Equivalent postoperative pain control was achieved with suppositories and oral medication, with few side effects and good tolerance. Furthermore, many parents preferred the suppositories to oral medication in maintaining postoperative pain control because of ease of administration.

Laryngoscope 2006 Aug;116(8):1485-8
Comparison of oral versus rectal administration of acetaminophen with codeine in postoperative pediatric adenotonsillectomy patients.
Click here to access the PubMed abstract of this article.

The use of topical morphine gel is reported in two children with epidermolysis bullosa, where acute inflammatory pain is a major symptom and where effective analgesia is a major clinical problem.

Arch Dis Child. 2004 Jul;89(7):679-81
Peripheral opioids in inflammatory pain.
Click here to access the PubMed abstract of this article.

Morphine sulfate 10 mg in Intrasite gel was applied topically to skin ulcers of hospice inpatients. The topical morphine was not absorbed in the majority of patients, suggesting any analgesic effect was mediated locally rather than systemically.

J Pain Symptom Manage. 2004 May;27(5):434-9
The bioavailability of morphine applied topically to cutaneous ulcers.
Click here to access the PubMed abstract of this article.