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

Emily Harrop1,2, Christina Liossi3,4, Liz Jamieson5,6

  • 1Helen and Douglas House Hospice, Oxford, UK.

BMJ Supportive & Palliative Care
|December 14, 2021
PubMed

Insights

Consensus was reached on using the buccal route for transmucosal diamorphine to manage breakthrough pain in children. Standardized pain scales were chosen to inform future pediatric palliative care trials.

Area of Science:

  • Palliative Care
  • Pediatric Pain Management
  • Clinical Trial Design

Background:

  • No randomized controlled trials exist for breakthrough pain in pediatric palliative care.
  • Standardized outcome measures for pediatric breakthrough pain are lacking.
  • This study aimed to inform a future randomized controlled trial on opioid administration for breakthrough pain in children.

Purpose of the Study:

  • To achieve consensus on design aspects for a prospective study.
  • To inform a future randomized controlled trial comparing oral morphine and transmucosal diamorphine.
  • To establish feasibility for a randomized controlled trial in pediatric palliative care.

Main Methods:

  • Nominal group technique used to achieve consensus.
  • Expert panel included 10 clinicians and 3 parent representatives.
  • Consensus defined as agreement with no further participant comments.

Main Results:

  • The buccal route was favored for administration.
  • Dosing followed the Association for Paediatric Palliative Medicine formulary.
  • The verbal Numerical Rating Scale, Faces Pain Scale-Revised, and FLACC/FLACC-Revised were selected for pain measurement.

Conclusions:

  • Consensus was reached for a small-scale prospective cohort study.
  • The study provides essential information for designing a future randomized controlled trial.
  • This work addresses the need for standardized outcome measures in pediatric palliative care.
Abstract

Keywords:
paediatricspain

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