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Pain control can lead to better outcomes for scleroderma digital ulcer debridement
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Controlling procedural pain in the debridement of scleroderma-associated digital ulcers led to better outcomes and treatment adherence among patients, according to new research.
The study monitored the treatment of 51 digital ulcers in 32 patients with systemic sclerosis (SSc) patients at a rheumatology unit in Modena, Italy, from January 2012 to December 2012. Procedural pain was addressed in a step-up manner, beginning with local lidocaine and/or prilocaine cream (25 mg/g of either or 5% EMLA cream). Depending on the severity of pain, local morphine was administered, then oral morphine.
Pain management during the debridement procedure was achieved using EMLA monotherapy in 33% of procedures. Of the 34 patients with moderate-to-severe pain, eight used combined therapy with EMLA and local morphine, and 26 used local and oral morphine.
Of all procedures, those requiring combined EMLA with local and oral morphine totaled 51%, and were more likely if the lesions were more severe or infected, according to the researchers.
During the follow-up period, scleroderma patients showed good compliance over the treatment cycle. Systemic prophylactic measures to prevent further development of digital ulcers included calcium channel blockers, prostanoids, anti-ET-1 and/or antibiotics.
Systemic and local treatments during follow-up led to the improvement of clinical features of the digital ulcers in more that 50% of patients, including the size, depth, perilesional erythema and infection. Only one patient did not respond to treatment, and digit amputation was required due to gangrene and osteomyelitis. The response to treatment was generally correlated to the severity of the digital ulcer at baseline along with the duration of treatment and number of debridement procedures, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
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