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European * clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain
Author(s) -
Häuser Winfried,
Morlion Bart,
Vowles Kevin E.,
Bannister Kirsty,
Buchser Eric,
Casale Roberto,
Chenot JeanFrançois,
Chumbley Gillian,
Drewes Asbjørn Mohr,
Dom Geert,
Jutila Liisa,
O'Brien Tony,
PogatzkiZahn Esther,
Rakusa Martin,
Suarez–Serrano Carmen,
Tölle Thomas,
Krčevski Škvarč Nevenka
Publication year - 2021
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1736
Subject(s) - medicine , discontinuation , observational study , medline , opioid , chronic pain , evidence based medicine , randomized controlled trial , clinical trial , clinical practice , systematic review , alternative medicine , intensive care medicine , physical therapy , psychiatry , surgery , receptor , pathology , political science , law
Background Opioid use for chronic non‐cancer pain (CNCP) is complex. In the absence of pan‐European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). Methods The clinical practice recommendations were developed by eight scientific societies and one patient self‐help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence‐based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case‐series, case‐control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. Results The key clinical practice recommendations suggest: (a) first optimizing established non‐pharmacological treatments and non‐opioid analgesics and (b) considering opioid treatment if established non‐pharmacological treatments or non‐opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence‐ and clinical consensus‐based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation. Conclusions Opioids remain a treatment option for some selected patients with CNCP under careful surveillance. Significance In chronic pain, opioids are neither a universal cure nor a universally dangerous weapon. They should only be used for some selected chronic noncancer pain syndromes if established non‐pharmacological and pharmacological treatment options have failed in supervised pain patients as part of a comprehensive, multi‐modal, multi‐disciplinary approach to treatment. In this context alone, opioid therapy can be a useful tool in achieving and maintaining an optimal level of pain control in some patients.