Topical morphine for cutaneous cancer pain.

Opioids are classically considered to have a central action, but opioid receptors have also recently been found in inflamed peripheral tissues.’ Intra-articular post-meniscectomy administration of low-dose morphine results in long-lasting analgesia,2 and although the possible mechanisms of peripheral opioid analgesia have been described in detail by Stein,3 clinical reports of such effects are rare. Recently, Back and Finlay4 suggested that topical diamorphine provides analgesia when applied to ulcerating cutaneous malignancies. Cutaneous pain is sometimes refractory even to high doses of systemic opioids. We report a case in which small doses of topical morphine provided useful analgesia. A 76-year-old woman was suffering from a nonHodgkin’s lymphoma of centroblastic type and intermediate malignancy. The tumour formed predominantly massive, confluent, elevated cutaneous lesions covering the face, scalp, chest and extremities. Chemotherapy with cyclophosphamide, mitozantrone, vincristine and prednisone was unsuccessful ; subsequent treatment with etoposide was also unhelpful. She deteriorated rapidly and was admitted to our hospice because of cutaneous pain, sleeplessness and progressive cachexia. On admission she complained of severe tension pain in her scalp, of an intensity of 5-7 on a 10-point numerical visual analogue scale (VAS), despite ibuprofen 400 mg tid. The lesion on her scalp was clearly inflamed and was tender to touch. There were several places which suggested blood extravasation. She was distressed by her altered body image and