| Title: | European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1 : role of opioids in the management of chronic noncancer pain |
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| Authors: | ID Hauser, Winfried (Author)
ID Morlion, Bart (Author)
ID Vowles, Kevin E. (Author)
ID Bannister, Kirsty (Author)
ID Buchser, Eric (Author)
ID Casale, Roberto (Author)
ID Chenot, Jean-François (Author)
ID Chumbley, Gillian (Author)
ID Drewes, Asbjørn M. (Author)
ID Dom, Gert (Author)
ID Jutila, Liisa (Author)
ID O'Brien, Tony (Author)
ID Pogatzky-Zahn, Esther (Author)
ID Rakuša, Martin (Author)
ID Suarez-Serrano, Carmen (Author)
ID Tölle, Thomas (Author)
ID Krčevski-Škvarč, Nevenka (Author) |
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| Files: |  Häuser-2021-European__clinical_practice_recomm.pdf (211,63 KB)
MD5: C44161E5E2E50426D07F27BB863E8C02
 https://doi.org/10.1002/ejp.1736
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| Language: | English |
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| Work type: | Scientific work |
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| Typology: | 1.01 - Original Scientific Article |
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| Organization: | MF - Faculty of Medicine
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| Abstract: | 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. |
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| Keywords: | pain, cronic disease, analgesia, opioid analgesics |
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| Publication status: | Published |
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| Publication version: | Version of Record |
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| Publication date: | 02.03.2021 |
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| Publisher: | Wiley |
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| Year of publishing: | 2021 |
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| Number of pages: | Str. 949-968 |
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| Numbering: | Letn. 25, Št. 5 |
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| PID: | 20.500.12556/DKUM-89886  |
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| UDC: | 616.8-009.7 |
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| ISSN on article: | 1532-2149 |
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| COBISS.SI-ID: | 53758467 |
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| DOI: | 10.1002/ejp.1736 |
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| Publication date in DKUM: | 16.08.2024 |
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| Views: | 262 |
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| Downloads: | 21 |
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| Metadata: |    |
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| Categories: | Misc.
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