Jun 11, 2021
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.