Needle-free, pain medicine for young patients (a prospective study)
Research type
Research Study
Full title
Feasibility of a randomised clinical trial of transmucosal diamorphine vs oral morphine for breakthrough pain in children and young people with life-limiting conditions. Acronym: DIPPER (DIamorphine Paediatric Palliative Evaluation of feasibility of Randomised controlled trial)
IRAS ID
273309
Contact name
Ian Wong
Contact email
Sponsor organisation
University College London
Clinicaltrials.gov Identifier
Z6364106/2020/03/69 , Data Protection registration
Duration of Study in the UK
0 years, 10 months, 31 days
Research summary
End of life care in children is very difficult for all concerned. For this to take place in the best possible way at home/place of choice, it is important that all pain is well managed. Therefore all pain needs to be treated immediately, with a medicine that acts quickly with minimum upsetting side effects, keeping the best possible quality of life.
At present there is not a good, fast acting, safe medicine for extra pain which occurs in dying babies, children and young people (breakthrough pain) on top of normal pain medicines given most of the time. Liquid morphine by mouth is usually given for breakthrough pain, taking up to thirty minutes to work. Fear of injections means that children and parents often put off asking for extra medicine, so needle-free, fast acting pain medicine, easy to give at home/place of choice, is needed. Diamorphine can be easily given under the tongue, up the nose, or into the cheek pouch (transmucosally), where the rich blood supply absorbs it almost as quickly as an injection. This feasibility study looks in detail at what needs to be considered when designing a future project to show how successful diamorphine is when given transmucosally, compared to usual treatment with morphine by mouth. Talking with children, families and those treating them, (Study 1A,IRAS project ID 252624) we aimed to find out views about using diamorphine in the ways suggested, what they feel most comfortable with and their feelings about taking part in research to decide whether or not diamorphine is good for breakthrough pain. We have determined how best to measure pain for these children from a systematic literature review and will test the feasibility of giving the medicine in the cheek/by mouth, using Association of Paediatric Palliative Medicine dosing guidelines and completion of pain questionnaires.
REC name
London - City & East Research Ethics Committee
REC reference
20/LO/0837
Date of REC Opinion
15 Jul 2020
REC opinion
Further Information Favourable Opinion