Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports

Abstract

Digital ulcers (DUs) are a severe and frequent clinical feature of patients with systemic sclerosis (SSc). The presence of DUs may cause severe pain and often lead to impairment of patient’s functional activities and health-related quality of life. Moreover, poor patient cooperation during the wound care procedure due to pain may be associated with a negative outcome of DU healing. Therefore, pain management has a key role in patients with SSc. These two case reports describe the effectiveness and safety of oxycodone/naloxone in patients with SSc complicated by painful chronic DUs. Such a therapy has provided pain relief and consequently an increased compliance during redressing wounds.

Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review

“…Studies have investigated the usefulness of topical analgesic drugs, especially opioids, for painful skin lesions including scleroderma. [10][11][12] However, a recent randomized controlled trial did not demonstrate any significant effect of topical morphine in chronic skin lesions. 13 Wound-related pain remains an area of significant and unmet need within scleroderma management.…”

“…Standardized analgesic strategies are not yet available for this condition, and little is known about volitional incident pain treatment. Studies have investigated the usefulness of topical analgesic drugs, especially opioids, for painful skin lesions including scleroderma 10–12 . However, a recent randomized controlled trial did not demonstrate any significant effect of topical morphine in chronic skin lesions 13 .…”

Infections of scleroderma digital ulcers: a single center cohort retrospective study

“…Noteworthy, chronic and procedural pain treatments using systemic and local analgesics are definitely required. 8 , 20 , 21 Elevated standard of health care, self-hygiene and asepsis during procedures are mandatory as well as careful surveillance of the hospital environment. Patient must be trained to pay specific attention to avoid infections, because one of the most important reservoirs is the patients’ endogenous flora (pathogens from the skin, mucous membranes and gastrointestinal tract).…”

Review of publications evaluating opioid use in patients with inflammatory rheumatic disease

“…Our literature search did not identify relevant recent publications examining the efficacy, tolerability, or side effects of oral opioids among patients with systemic sclerosis. There is sparse prior literature in systemic sclerosis discussing the efficacy of opioid analgesics to manage painful skin ulcers [42][43]. Since these patients often experience pain from inflammatory arthritis and other disease manifestations, we suspect a large proportion of patients with systemic sclerosis may be receiving chronic opioids.…”