European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1Hauser, Winfried (Avtor) Morlion, Bart (Avtor) Vowles, Kevin E. (Avtor) Bannister, Kirsty (Avtor) Buchser, Eric (Avtor) Casale, Roberto (Avtor) Chenot, Jean-François (Avtor) Chumbley, Gillian (Avtor) Drewes, Asbjørn M. (Avtor) Dom, Gert (Avtor) Jutila, Liisa (Avtor) O'Brien, Tony (Avtor) Pogatzky-Zahn, Esther (Avtor) Rakuša, Martin (Avtor) Suarez-Serrano, Carmen (Avtor) Tölle, Thomas (Avtor) Krčevski-Škvarč, Nevenka (Avtor) paincronic diseaseanalgesiaopioid analgesicsBackground: 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.Wiley20212024-08-16 10:11:03Znanstveno delo89886sl