Clinician Attitudes towards Analgesia for Chronic Limb Threatening Ischaemia: A Survey of Vascular Specialists to Inform a Topical Morphine Trial.

Davies, H.; Vleugels, MJ.; Kwong, M.; Dua, A.; Akhtar, N.; Mees, BME.; Mitchell, S.; Russell, D.

Clinician Attitudes towards Analgesia for Chronic Limb Threatening Ischaemia: A Survey of Vascular Specialists to Inform a Topical Morphine Trial.

All Authors

Davies, H.

Vleugels, MJ.

Kwong, M.

Dua, A.

Akhtar, N.

Mees, BME.

Mitchell, S.

Russell, D.

LTHT Author

Davies, Henry
Russell, David

LTHT Department

Trauma & Related Services
Vascular Surgery
Leeds Vascular Institute

Publication Date

2026

Item Type

Journal Article

Subject

ANALGESICS , ISCHAEMIA , MORPHINE , PAIN MANAGEMENT , PERIPHERAL VASCULAR DISEASES , DRUG ADMINISTRATION ROUTES

Abstract

Objective: Current analgesic strategies often treat pain associated with chronic limb threatening ischaemia (CLTI) inadequately and frequently result in significant side effects. This cross sectional, web based, vascular specialist survey study aimed to explore clinician perspectives on current pain management and the potential role of topical morphine to inform future research in this area. Methods: A cross sectional online survey was distributed to vascular surgeons, physicians, and allied health professionals involved in the care of patients with CLTI. The 16 question survey included both closed and open ended items exploring perceptions of current analgesia adequacy, experience with topical morphine (e.g., morphine in gel preparations), and attitudes toward future clinical research. The questionnaire was disseminated via national and international vascular societies, professional mailing lists, and social media platforms. Responses were recorded anonymously and stratified using five point Likert scales (strongly disagree to strongly agree). Results: Of the 104 respondents, most were consultant vascular surgeons (57%) or speciality registrars (14%), with the majority based in the UK (89%). Pain control for CLTI was rated as suboptimal by 96% of respondents in outpatient settings and 78% in inpatient settings. No respondents strongly agreed that pain was adequately managed in either context. Only eight respondents reported experience using topical morphine; of these, three reported it as effective most of the time and five said it was effective sometimes. Nonetheless, 79% expressed willingness to randomise patients with ulcers to a trial of topical morphine, and 85% were willing to include patients without ulcers. All but one of the 104 respondents agreed that reducing systemic analgesia would be of significant patient benefit. Conclusion: There is both a clinical need and strong support among vascular clinicians for research into optimised analgesic regimens for CLTI. Despite limited current experience with topical morphine, the majority are willing to recruit to a trial.