pilot study: kerastat® gel for topical delivery of morphine for management of non-healing, painful open wounds and ulcers

Conditions: Wound of Skin; Burns

Summary: this study is intended to provide information from subjects who currently have painful, chronically open wounds and assess the pain reduction capacity of kerastat® gel with morphine. in gathering data from subjects who have baseline pain from their chronically open wounds, the investigators can then evaluate the capacity of kerastat® gel plus morphine in reducing the subjects daily pain levels, pain associated with dressing changes, and pain medication consumption.

chronic wounds pose a serious challenge to wound care professionals, as open and non-healing ulcers are often painful and difficult to treat. patients are less compliant because of their pain and also run the risk of increased pain medication exposure in treating these wounds. a great deal of healthcare resources are dedicated to the treatment of non-healing open wounds. kerastat® gel offers a novel method for the topical delivery of morphine to manage pain during the treatment of healing these problematic wounds. proof of concept work showed that a single treatment application of opioid-loaded keratin hydrogels produced extended analgesia that lasted up to two days in both sensitized and non-sensitized models of pain in rodents. this work then moved the proposed product into a porcine large animal study that showed topical morphine did not delay wound healing or re-epithelization and did not impact dermal thickness or transforming growth factor beta 1 (tgf1). additionally, pharmacokinetics assessments showed that topical delivery of morphine to a burn wound resulted in no detectable morphine in animal serum. kerastat® gel is a sterile, non-implantable, water-based gelatinous (hydrogel) wound dressing intended to act as a protective covering in the management of a variety of partial thickness dermal wounds. keratin is a structural, filamentous protein that, when hydrated, forms a hydrogel that provides coverage and maintains a moist environment for injured skin, similar to collagen and other extracellular matrix molecules used in existing products. therefore, kerastat® gel is expected to behave in an equivalent manner to conventional biopolymer wound dressings. iso 10993 biocompatibility studies and performance testing, both in vitro and in vivo, indicated that kerastat® gel is safe and biocompatible. additionally, two clinical studies support the assertion that the product is non-sensitizing, non-irritating, and does not produce a humoral response. the current study is designed to provide pilot data to inform a power calculation to determine whether kerastat® gel plus morphine reduces pain associated with dressing changes which may secondarily reduce daily pain and pain medication consumption. this study is intended to evaluate the efficacy of kerastat® gel with morphine in treating and/or minimizing the pain associated with chronic open wounds and subsequently replace or reduce the need for systemic analgesia. long-term impacts include improving tolerance to dressing changes resulting in better adherence to the treatment of painful open wounds, as well as giving providers an alternative to systemic narcotics which are dangerous, have many negative side effects, and are highly addictive. data from this project will also support further studies in evaluating and assessing patients who have painful wounds and their chronic management.

Eligibility criteria:
inclusion criteria: 1. subjects age 18 or older able to provide informed consent. 2. ulcer size 1-300 cm2 4. undermining/tunneling \<3 cm from wound margin 5. grossly free of necrotic and/or infected tissue 6. baseline minimum of 2 on vas pain scale exclusion criteria: subjects who meet any of the following criteria will be excluded from the study: 1. known allergy to the standard of care or any of the ingredients in kerastat® gel or to morphine 2. wound has heavy or high-volume exudate or necrotic tissue 3. clinical signs of infection or contamination of the wound 4. subjects unable to complete the vas pain score in pain journal 5. pregnant or nursing 6. prisoner 7. any condition the investigator determines will compromise subject safety or prevent the subject from completing the study