Topical crushed morphine tablets for dressing-related pain in a malignant fungating wound in a resource-limited palliative care setting

Malignant fungating wounds are often linked to severe dressing-related pain that may continue despite adequate systemic opioid treatment. Topical opioids have shown pain relief in small clinical studies and case series, most often in compounded hydrogel formulations. We describe a woman in her 70s with metastatic breast cancer and a painful, malignant, fungating wound managed in a palliative care unit in India. In addition to systemic oral morphine, crushed immediate-release morphine tablets (20 mg) were applied directly to the ulcer during dressing changes, due to the unavailability of compounded preparations. This approach consistently reduced dressing-related incident pain (from 7–8/10 to 3–4/10), enhanced patient tolerance of wound care and showed no signs of local irritation or systemic opioid toxicity over 12 days. In resource-limited settings without access to compounded medications and advanced wound care products, applying crushed morphine tablets directly could be a practical, affordable method to manage incident pain associated with malignant wounds. This technique might also be useful in other palliative care situations within similar low- and middle-income country environments.