Three Part Question
In [patients with a myocardial infarction] is [morphine better than diamorphine] at [alleviating chest pain]?
A 55 year old man presents to the emergency department with chest pain. An ECG shows changes consistent with acute myocardial infarction. He is given aspirin and oxygen. His thrombolytic therapy is commenced and in the meantime you wonder whether his pain would be best alleviated by either morphine or diamorphine.
Medline 1966-10/03 using the OVID ATHENS interface.
Including MEDLINE in progress and non-indexed citations.
[(exp chest pain OR exp myocardial infarction OR myocard$.mp OR infarct$.mp OR MI.mp) AND (exp morphine OR morphine.mp OR heroin.mp OR diamorphine.mp OR analg$.mp OR exp analgesics, opioid) AND (exp clinical trials OR exp randomized controlled trials OR randomized controlled trial.mp)] LIMIT to human AND English.
Altogether 56 papers were identified of which only one was relevant. Details of this paper are shown in the table.
|Author, date and country
||Study type (level of evidence)
|Scott ME and Orr R,|
|118 patients aged 30-79 yrs with moderate to severe chest pain||PRCT||Complete pain relief at 10 min||47% v 32% (p<0.05)||Randomization unclear
Confidence intervals not stated
|Complete pain relief at 30 min||NSD|
|Complete pain relief at 60 min||NSD|
This is the only paper identified that compares morphine and diamorphine in this clinical situation. The doses were fixed.
Clinical Bottom Line
There are no significant clinical differences between diamorphine and morphine in patients with chest pain.
Level of Evidence
Level 2 - Studies considered were neither 1 or 3.
- Scott ME, Orr R. Effects of diamorphine, methadone, morphine, and pentazocine in patients with suspected acute myocardial infarction. Lancet 1969;1;1065-7.