{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:20:43Z","timestamp":1788261643040,"version":"build-2803163510"},"reference-count":12,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,14]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>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.<\/jats:p>\n                  <jats:p>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\u2009mg) 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\u20138\/10 to 3\u20134\/10), enhanced patient tolerance of wound care and showed no signs of local irritation or systemic opioid toxicity over 12 days.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2026-273958","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:10:18Z","timestamp":1788261018000},"page":"e273958","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Topical crushed morphine tablets for dressing-related pain in a malignant fungating wound in a resource-limited palliative care setting"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2429-4966","authenticated-orcid":false,"given":"Darshak","family":"Sanyal","sequence":"first","affiliation":[{"name":"Manipal Hospice and Respite Centre, Havanje, India"},{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9975-2568","authenticated-orcid":false,"given":"Arun","family":"Ghoshal","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, India"},{"name":"Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuja","family":"Damani","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, India"},{"name":"Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema R","family":"Rao","sequence":"additional","affiliation":[{"name":"Manipal Hospice and Respite Centre, Havanje, India"},{"name":"Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"2026090104100958000_19.9.e273958.1","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2019.00373","article-title":"The Microbiome, Malignant Fungating Wounds, and Palliative Care","volume":"9","author":"Vardhan","year":"2019","journal-title":"Front Cell Infect Microbiol"},{"key":"2026090104100958000_19.9.e273958.2","first-page":"503","article-title":"A Patient-Centered Approach for the Treatment of Fungating Breast Wounds","volume":"11","author":"Rupert","year":"2020","journal-title":"J Adv Pract Oncol"},{"key":"2026090104100958000_19.9.e273958.3","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16508"},{"key":"2026090104100958000_19.9.e273958.4","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2008\/11\/S105"},{"key":"2026090104100958000_19.9.e273958.5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/15360288.2022.2084488","article-title":"Topical Morphine Gel as a Systemic Opioid Sparing Technique","volume":"36","author":"Klosko","year":"2022","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"2026090104100958000_19.9.e273958.6","unstructured":"Topical opioid use in dermatologic disease: a systematic review - Gutierrez - 2021 - dermatologic therapy - Wiley Online Library. Available: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/dth.15150?msockid=036f08e77ce1692c2c501ffc7d7a68bc [Accessed 15 Jun 2026]."},{"key":"2026090104100958000_19.9.e273958.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2007.04.016"},{"key":"2026090104100958000_19.9.e273958.8","doi-asserted-by":"crossref","first-page":"e557","DOI":"10.1016\/j.jpainsymman.2023.02.098","article-title":"Just a Sprinkle a Day Takes the Pain Away: Incorporating Topical Opioids for Wound Pain (CS336)","volume":"65","author":"Vega","year":"2023","journal-title":"J Pain Symptom Manage"},{"key":"2026090104100958000_19.9.e273958.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2008.06.007"},{"key":"2026090104100958000_19.9.e273958.10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1248\/yakushi.126.315","article-title":"Evaluation of binders in the preparation of medicinal carbon tablets by wet granule compression","volume":"126","author":"Ito","year":"2006","journal-title":"Yakugaku Zasshi"},{"key":"2026090104100958000_19.9.e273958.11","first-page":"E37","article-title":"Morphine Versus Loperamide with Intrasite Gel in the Treatment of Painful Dermal Ulcers: A Randomized, Crossover Study","volume":"24","author":"Jyothi","year":"2021","journal-title":"Pain Physician"},{"key":"2026090104100958000_19.9.e273958.12","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1089\/wound.2023.0037","article-title":"Morphine (10, 20\u2009mg) in a Postoperative Dressing Used with Patients After Surgical Debridement of Burn Wounds: A Prospective, Double-Blinded, Randomized Controlled Trial","volume":"13","author":"Kowalski","year":"2024","journal-title":"Adv Wound Care"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273958","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:10:20Z","timestamp":1788261020000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":12,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,1]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-273958"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273958","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}