Opioid Treatment Impedes Healing in Chronic Wounds

Patients with chronic wounds who never receive opioids heal faster than those who do receive the analgesic drugs, according to a new study.

Researchers at George Washington University (GW, Washington, DC, USA) conducted a longitudinal observational study involving 450 subjects in order to investigate the association between opioid exposure and chronic wound outcomes, since opioids are routinely used as analgesics in these patients. Data were collected prospectively, including baseline characteristics, pain score, longitudinal opioid exposure, and total wound surface area (tWSA).

The results showed opioid dose was significantly associated with tWSA, after accounting for the effects of pain score and baseline co-variates. For each unit increase in opioid dose, tWSA increased by 0.16 units. Using time-to-event analysis, the researchers found that patients who never received opioids at all healed faster than those who had received them, and patients who received a mean opioid dose higher than 10mg were significantly less likely to heal than those with no opioid, after adjustment for wound size. The study was published on November 16, 2016, in Wound Repair and Regeneration.

“Opioid analgesics are commonly prescribed to patients with chronic wounds, but until now, little to no research had been done to determine the relationship between opioid treatment and wound healing,” said lead author Victoria Shanmugam, MD, of the GW School of Medicine and Health Sciences. “It seems that exposing patients to opioids may impact ultimate wound outcome. More work needs to be done to understand this finding and the possible mechanisms driving it.”

Opioids act by binding to receptors found principally in the central and peripheral nervous system, and the gastrointestinal (GI) tract, which mediate both the psychoactive and somatic effects of opioids. Primarily used for pain relief, opioids are also used to suppress cough and diarrhea. Side effects include itchiness, sedation, nausea, respiratory depression, constipation, and euphoria. Accidental overdose or concurrent use with other depressant drugs commonly results in death from respiratory depression. Because of opioid drugs' reputation for addiction and fatal overdose, most are controlled substances.

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