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Barriers to the use of buccal and intranasal fentanyl for breakthrough pain in paediatric palliative care: an exploratory survey
  1. Emily Harrop1,
  2. Liz Jamieson2,
  3. Tsun Ho Choy3,
  4. Wing Hei Phoebe Ho3 and
  5. Ian C K Wong2
  1. 1 Helen and Douglas House Hospices, Oxford, UK
  2. 2 University College London School of Pharmacy, London, UK
  3. 3 Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Emily Harrop, Helen and Douglas House Hospices, Oxford, Oxfordshire OX4 1RW, UK; emilyharrop{at}

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We recently administered a survey to investigate the prescribing of buccal and intranasal fentanyl for breakthrough pain in paediatric palliative care in the UK.

A Cochrane review did not find any evidence for how breakthrough pain should be managed in palliative care.1 Meta-analyses of randomised controlled trials have demonstrated increased efficacy of fentanyl compared with oral morphine,2 while pharmacokinetic studies highlight the onset and duration properties of fentanyl dosage forms that might be beneficial to certain patients experiencing breakthrough pain. Various dosage forms of fentanyl have been licenced for use in breakthrough cancer pain in adults, but UK National Institute for Health and Care Excellence (NICE) (2012) guidelines addressing strong opioid use in palliative care patients state that fentanyl should not be offered as first-line rescue medication. A lack of paediatric data for commercially available fentanyl transmucosal application systems means these products have traditionally not been recommended for first-line use in children.

The aim of this survey was to investigate current off-label prescribing of fentanyl for breakthrough pain relief in paediatric palliative care and to ascertain any barriers to use. This is timely as one of the research recommendations in the NICE guidelines (2016) on end of life care for infants, children and young people with life-limiting conditions related to managing breakthrough pain.3

An anonymous online survey was delivered via Qualtrics to …

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  • Contributors EH codesigned the survey and contributed significantly to the manuscript. LJ codesigned the survey, administered the survey via Qualtrics, analysed the data with THC and WHPH and revised the initial and subsequent manuscripts. THC and WHPH analysed the data and drafted and contributed to the manuscript. ICKW designed the survey and contributed to the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The survey was approved by UCL Ethics Committee.

  • Provenance and peer review Not commissioned; internally peer reviewed.