Presented at the 2012 AAPM Annual Meeting « Back

Topical Opioids in Central Intractable Pain

Forest S. Tennant, MD DrPH, veractinc@msn.com, Veract Intractable Pain Clinic, West Covina, California

Introduction/Statement of Problem: This investigation was done to determine if topical opioids may relieve peripheral symptoms experienced by patients with intractable central pain.1-3 Materials and Methods: Thirty-seven (37) patients between the ages of 31 and 82 years and maintained on systemic opioids, had presumed central, intractable pain. They had constant pain or at least 2 years, had failed numerous peripheral treatments, and reported periods of allodynia and/or hyperalgesia. The protocol was approved by the Facilities Institutional Review Board. Subjects were given one or more of the following agents dissolved in one ounce of cold cream: morphine 30 to 90mg, oxycodone 30 to 90mg, hydromorphone 8 to 24mg, or carisoprodol 350 to 1050mg. Patients were to use their topical preparations in a manner to maximize pain relief. Data was collected by written questionnaire after the patient had used their topical opioid for at least 90 days. Results: All patients reported that pain relief occurred within 10 minutes and lasted up to 4 hours. Reasons to use their topical were: when aching begins (64.9%), flares (67.6%), burning or itching begins (24.3%), get out of bed each morning (29.7%) hurts to touch (16.2%), and helps sleep (43.2%). Conclusions: Central pain impairs the normal inhibition of descending pain signals that emanate from the CNS and which may be associated with allodynia, hyperalgesia, and flare pain. Patients reported that topical opioids temporarily relieved troublesome symptoms. References: 1)Jaris JL, Dubneer R, Hargraves KM. Opioid analgesia at peripheral sites: a target for opioids released during stress and inflammation. Anesth Analg 1987;66:1277-81. 2)Stein C, Millan MJ, Shippenberg TS, et al. Peripheral opioid receptors mediating antisciception in inflammation: evidence for involvement of mu, delta, and kappa receptors. J Pharmacol Exp Ther 1989;248:1269-75. 3)Tennant FS. Taking advantage of the peripheral opioid receptors. Prac Pain Manag 2010;10:28-30.

Funding: None