[Pharmacological management of pain in chronic wounds and stomas in adult patients].

Pain associated with chronic wounds and stomas is a frequent and complex clinical problem that is often underestimated and undertreated. Its pathophysiology is multifactorial, since it combines nociceptive, inflammatory, and neuropathic mechanisms, which justifies the need for a comprehensive, multimodal pharmacological approach. This review critically analyzes recent evidence on systemic, topical, and adjuvant treatments used for the management of baseline pain, procedure-related pain, neuropathic pain, and breakthrough pain in patients with chronic wounds or stomas. Systematic reviews, clinical trials, and clinical practice guidelines published over the past 5 years were included. Non-opioid analgesics and opioids remain as the cornerstone of pharmacological treatment; however, their effectiveness may be limited when neuropathic components are unrecognized or poorly characterized. Topical formulations of local anesthetics, opioids, and emerging agents have demonstrated benefits, particularly in pain associated with wound care and local procedures. Likewise, gabapentinoids and dual-action antidepressants are effective in the management of neuropathic pain, while rapid-onset opioids may be considered for breakthrough pain in selected clinical contexts. Although the available evidence is heterogeneous, it supports an individualized approach that integrates different mechanisms of action and considers wound or stoma characteristics, patient comorbidities, and clinical safety aspects.