Skip to main content
SpringerLink
Log in

Schmerzreduktion bei Patienten mit chronischem Ulcus cruris durch ein neu entwickeltes Morphingel

Erste Resultate einer klinischen Untersuchung

A new topically applied morphine gel for the pain treatment in patients with chronic leg ulcers

First results of a clinical investigation

  • Originalien
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Neben der essenziell wichtigen Diagnostik und Behandlung der zugrunde liegenden Erkrankungen ist es ein wesentliches Ziel des komplexen Behandlungskonzeptes der Patienten mit einem chronischen Ulcus cruris, eine adäquate Analgesie zu erreichen. Wir haben daher ein neues, mit Polihexanid konserviertes Morphingel für die topische Wundbehandlung entwickelt.

Patienten und Methoden

Insgesamt haben wir bislang 30 Patienten mit einem schmerzhaften chronischen Ulcus cruris und einem durchschnittlichen Lebensalter von 66 Jahren untersuchen können. Die jeweilige Schmerzstärke wurde mittels einer visuellen Analogskala (VAS), die von 0–10 reicht, objektiviert.

Ergebnisse

Die Schmerzstärke der untersuchten Patienten betrug vor der topischen Applikation des Morphingels mindestens 4 und im Mittelwert 7,8. Der nach 24 h erneut objektivierte Wert konnte signifikant auf 4,5 im Mittelwert gesenkt werden. Nebenwirkungen oder Unverträglichkeiten konnten bislang nicht beobachtet werden.

Schlussfolgerung

Diese ersten klinischen Daten mit einem neu entwickelten Morphingel ermöglichen es, zumindest über den Beobachtungszeitraum von jeweils 24 h die Vorteile einer modernen feuchten Wundtherapie mit denen einer lokalen Schmerztherapie zu kombinieren. Insofern stellt diese in weiteren klinischen Studien zu untersuchende Neuentwicklung eine hoffnungsvolle Therapieoption für die praktische Behandlung von Patienten mit schmerzhaftem Ulcus cruris dar.

Abstract

Background

The approach to patients with chronic leg ulcers should include not only an accurate diagnosis with appropriate therapy fort he underlying disease, but also the development of effective analgesia. To assess the analgesic effect of topical morphine, we developed a new morphine gel with polihexanide as a preservative for the local pain treatment.

Patients and methods

We have studied 30 patients with painful chronic leg ulcers with an average age of 66 years. The respective pain intensity was assessed 24 hours after application of the morphine hydrogel and objectified with a visual analogue scale (VAS) ranged from 0 to 10.

Results

All investigated patients had a pain intensity of at least 4 points before the topical application of the morphine gel; the average pain intensity was 7.8. After application of the morphine gel, a significant reduction of the average pain intensity was observed, with an average pain intensity of 4.5.

Conclusion

These first clinical results with the new morphine gel suggest that at least fort he first 24 hours it combines the advantages of a moist wound healing and a local pain treatment. This new development is certainly a promising therapeutic alternative for pain treatment in patients with chronic leg ulcers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. ABDA – Bundesvereinigung Deutscher Apothekerverbände (2010) Neues Rezeptur Formularium, Rezepturhinweise: Morphin zur Anwendung auf der Haut. Stand 26.07.2010. Pharmazeutische Zeitung online

  2. Ashfield T (2005) The use of topical opioids to relieve pressure ulcer pain. Nurs Stand 19:90–92

    PubMed  Google Scholar 

  3. Beldon P (2009) Topical dressings to manage pain in venous leg ulceration. Br J Community Nurs 14:S6–S10

    PubMed  Google Scholar 

  4. Breivik E, Bjornsson G, Skovlund E (2000) A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 16:22–28

    Article  PubMed  CAS  Google Scholar 

  5. Briggs M, Ferris F, Glynn C et al (2004) Assessing pain at wound dressing-related procedures. Nurs Times 100:56–57

    PubMed  Google Scholar 

  6. Briggs M, Nelson E (2003) Topical agents or dressings for pain in venous leg ulcers. Cochrane Database Syst Rev:CD001177

    Google Scholar 

  7. Dissemond J, Kramer A, Riepe G et al (2009) Praxisorientierte Expertenempfehlung zur Behandlung kritisch-kolonisierter und lokal infizierter Wunden mit Polihexanid. ZFW 14:20–26

    Google Scholar 

  8. Flock P (2003) Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain. J Pain Symptom Manage 25:547–554

    Article  PubMed  CAS  Google Scholar 

  9. Freise J, Kohaus S, Korber A et al (2008) Contact sensitization in patients with chronic wounds: results of a prospective investigation. J Eur Acad Dermatol Venereol 22:1203–1207

    Article  PubMed  CAS  Google Scholar 

  10. Gallenkemper G, Rabe E, Bauer R (1998) Contact sensitization in chronic venous insufficiency: modern wound dressings. Contact Dermatitis 38:274–278

    Article  PubMed  CAS  Google Scholar 

  11. Goncalves Ml, De Gouveia Santos Vl, De Mattos Pimenta C et al (2004) Pain in chronic leg ulcers. J Wound Ostomy Continence Nurs 31:275–283

    PubMed  Google Scholar 

  12. Gottrup F, Jorgensen B, Karlsmark T et al (2008) Reducing wound pain in venous leg ulcers with Biatain Ibu: a randomized, controlled double-blind clinical investigation on the performance and safety. Wound Repair Regen 16:615–625

    Article  PubMed  Google Scholar 

  13. Guarnera G, Tinelli G, Abeni D et al (2007) Pain and quality of life in patients with vascular leg ulcers: an Italian multicentre study. J Wound Care 16:347–351

    PubMed  CAS  Google Scholar 

  14. Hirsch T, Jacobsen F, Rittig A et al (2009) A comparative in vitro study of cell toxicity of clinically used antiseptics. Hautarzt 60:984–991

    Article  PubMed  CAS  Google Scholar 

  15. Hirsch T, Körber A, Jacobsen F et al (2010) Evaluation of toxic side effects of clinically used skin antiseptics in vitro. J Surg Res 164:344–350

    Article  PubMed  CAS  Google Scholar 

  16. Iriarte Sotés P, López Abad R, Gracia Bara MT et al (2010) Codeine-induced generalized dermatitis and tolerance to other opioids. J Investig Allergol Clin Immunol 20:89–90

    Google Scholar 

  17. Jansen M, Horst J Van Der, Valk P Van Der et al (2009) Pain-relieving properties of topically applied morphine on arterial leg ulcers: a pilot study. J Wound Care 18:306–311

    PubMed  CAS  Google Scholar 

  18. Jorgensen B, Friis G, Gottrup F (2006) Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of Biatain-Ibu, a new pain reducing wound dressing. Wound Repair Regen 14:233–239

    Article  PubMed  Google Scholar 

  19. Körber A, Schadendorf D, Dissemond J (2009) Causes of leg ulcers. Analysis of the data from a dermatologic wound care center. Hautarzt 60:483–488

    Article  PubMed  Google Scholar 

  20. Kramer A, Kammerlander G, Andriessen A et al (2004) Konsensusempfehlung zur Auswahl von Wirkstoffen für die Wundantiseptik. ZfW 3:110–120

    Google Scholar 

  21. Lehnen M, Kohaus S, Körber A et al (2006) Contact allergies in patients with chronic wounds: results of a study from 1999 to 2004. Hautarzt 57:303–306, 308

    Article  PubMed  CAS  Google Scholar 

  22. Reddy M, Kohr R, Queen D et al (2003) Practical treatment of wound pain and trauma: a patient-centered approach. An overview. Ostomy Wound Manage 49:2–15

    PubMed  Google Scholar 

  23. Rosenthal D, Murphy F, Gottschalk R et al (2001) Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers. J Wound Care 10:503–505

    PubMed  CAS  Google Scholar 

  24. Saap L, Fahim S, Arsenault E et al (2004) Contact sensitivity in patients with leg ulcerations: a North American study. Arch Dermatol 140:1241–1246

    Article  PubMed  Google Scholar 

  25. Santacana E, Aliaga L, Bayo M et al (1993) EMLA. A new topical anesthetic. Rev Esp Anestesiol Reanim 40:284–291

    PubMed  CAS  Google Scholar 

  26. Schnuch A, Geier J, Uter W et al (2007) The biocide polyhexamethylene biguanide remains an uncommon contact allergen. Contact Dermatitis 56:235–239

    Article  PubMed  CAS  Google Scholar 

  27. Stahl M, Meyer C, Haas E et al. (2008) Leg ulcer progression caused by topical anesthesia with EMLA cream. J Dtsch Dermatol Ges 6:566–568

    Article  PubMed  Google Scholar 

  28. Suhonen R, Kanerva L (1997) Contact allergy and cross-reactions caused by prilocaine. Am J Contact Dermat 8:231–235

    Article  PubMed  CAS  Google Scholar 

  29. Tran Qn, Fancher T (2007) Achieving analgesia for painful ulcers using topically applied morphine gel. J Support Oncol 5:289–293

    PubMed  CAS  Google Scholar 

  30. Valenzuela AR, Perucho NS (2008) The effectiveness of a 0.1% polyhexanide gel. Rev Enferm 31:7–12

    PubMed  Google Scholar 

  31. Vernassiere C, Cornet C, Trechot P et al (2005) Study to determine the efficacy of topical morphine on painful chronic skin ulcers. J Wound Care 14:289–293

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    L. Huptas, N. Rompoti, A. Körber, J. Klode, D. Schadendorf &  J. Dissemond

  2. Apotheke, Universitätsklinikum Essen, Essen, Deutschland

    S. Herbig

Authors
  1. L. Huptas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Rompoti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Herbig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Körber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Klode
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Schadendorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Dissemond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Dissemond.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huptas, L., Rompoti, N., Herbig, S. et al. Schmerzreduktion bei Patienten mit chronischem Ulcus cruris durch ein neu entwickeltes Morphingel. Hautarzt 62, 280–286 (2011). https://doi.org/10.1007/s00105-011-2141-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-011-2141-x

Schlüsselwörter

Keywords

Search

Navigation