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.