Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus

Title

Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus

Creator

Harrop E; Liossi C; Jamieson L; Gastine S; Oulton K; Skene SS; Howard RF; Johnson M; Boyce K; Mitchell L; Jassal S; Anderson AK; Hain R; Hills M; Bayliss J; Soman A; Laddie J; Vickers D; Mellor C; Warlow T; Wong IC

Publisher

BMJ Supportive & Palliative Care

Date

2021

Subject

Oral morphine; paediatrics; pain; transmucosal diamorphine

Description

OBJECTIVES: No randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine. METHODS: The nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming. RESULTS: The panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools. CONCLUSIONS: The nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

February 2022 List

Collection

Citation

Harrop E; Liossi C; Jamieson L; Gastine S; Oulton K; Skene SS; Howard RF; Johnson M; Boyce K; Mitchell L; Jassal S; Anderson AK; Hain R; Hills M; Bayliss J; Soman A; Laddie J; Vickers D; Mellor C; Warlow T; Wong IC, “Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus,” Pediatric Palliative Care Library, accessed June 30, 2022, https://pedpalascnetlibrary.omeka.net/items/show/17797.

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