Healthcare professionals’ views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: a focus group study (DIPPER)'

SAGE Palliative Medicine & Chronic Care

This episode features Dr Liz Jamieson (Research Department of Practice and Policy, University College London School of Pharmacy, London, UK). Oral morphine is the recommended first line treatment for breakthrough pain. Intranasal diamorphine is an effective, rapid onset, well tolerated treatment for use in Accident and Emergency (ED) for trauma patients but lacks study in paediatric palliative care. It is often assumed that large scale clinical trials are not feasible in a paediatric palliative care population. Highlights the variation in experience of use of transmucosal diamorphine for breakthrough pain. Reports clinicians’ experience of the benefits of transmucosal diamorphine in the absence of data for breakthrough pain in children receiving palliative care and highlights their concerns in regard to the feasibility of running a randomised controlled trial of oral morphine versus transmucosal diamorphine. Evidence that many of the identified barriers to wider use of transmucosal diamorphine could be overcome by offering education and undertaking research, potentially leading to a licensed preparation. Clinicians identified clinical scenarios where transmucosal diamorphine may be preferable but identified several current barriers to its use. Access to a safe and effective preparation of transmucosal diamorphine would provide a range of options with which clinicians could flexibly target breakthrough pain in different clinical scenarios. This adds to the case for undertaking research in this population despite perceived challenges.