European* clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain

Haüser, Winfried; Morlion, Bart; Vowles, Kevin E.; Bannister, Kirsty; Buchser, Eric; Casale, Roberto; Chenot, Jean‐François; Chumbley, Gillian; Drewes, Asbjørn Mohr; Dom, Gert; Jutila, Liisa; O’Brien, Tony; Pogatzky‐Zahn, Esther; Ragusa, Martín; Suárez-Serrano, Carmen; Tölle, Thomas R.; Krcevski–Škvarc, Nevenka

doi:10.1002/ejp.1736

Cited by 77 publications

(77 citation statements)

References 74 publications

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“…Long-term opioid treatment for CNCP is under debate globally because of the opioid epidemic in the United States (Chou et al, 2020). In European guidelines, opioids remain a treatment option in carefully selected and supervised patients with CNCP for whom established non-pharmacological therapies and nonopioid analgesics have failed or have not been tolerated (Häuser et al, 2021;Petzke et al, 2020). The health claims data which have been used to find the indication for opioid prescriptions do not allow to draw conclusions if the indication was appropriate.…”

Section: Indications For Opioid Therapymentioning

confidence: 99%

Is Europe also facing an opioid crisis?—A survey of European Pain Federation chapters

Haüser

Buchser

Finn

et al. 2021

European Journal of Pain

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Section: Indications For Opioid Therapymentioning

confidence: 99%

Is Europe also facing an opioid crisis?—A survey of European Pain Federation chapters

Haüser

Buchser

Finn

et al. 2021

European Journal of Pain

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“…When discussing treatment options for patients with CNCP, the potential risk of increased all‐cause mortality associated with opioids should be included to the numerous known harms of this category of medication. Nevertheless, for some patients, the therapeutic benefits from opioids may outweigh the small absolute risk of increased mortality – especially, if the alternative treatments are not effective, poorly tolerated or contraindicated (Häuser, Bock, et al., 2020; Häuser et al., 2021).…”

Section: Discussionmentioning

confidence: 99%

Is opioid therapy for chronic non‐cancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

Tölle

Fitzcharles

Haüser

2021

European Journal of Pain

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Background The many risks associated with opioid therapy for chronic non‐cancer pain (CNCP) have led to questions about use. This is particularly relevant for risk of increased mortality. However, underlying medical conditions of those using opioids may influence mortality findings due to confounding by indication. Similarly, non‐opioid analgesics are also associated with an increased risk of mortality, too. Methods We have conducted a systematic review of propensity score matched observational studies comparing mortality associated with opioid use compared to non‐opioid analgesics. Clinicaltrials.gov, Google Scholar, MEDLINE and Scopus were searched from inception to July 2020. Propensity score matched observational studies comparing opioids to non‐opioid analgesics in real‐world settings were analysed. Primary outcome was pooled adjusted hazard ratio (aHR) of all‐cause death. Effects were summarized by a random effects model. Results Four studies with seven study arms and 120,186 patients were analysed. Pooled aHR for all‐cause death was 1.69 (95% confidence interval [CI] 1.47, 1.95). When mortality risk was confined to out‐of‐hospital deaths, the pooled aHR was 2.12 (95% CI 1.46, 3.09). The most frequent cause of death was cardiovascular death. Before matching, patients with opioids were older and had more somatic diseases than patients with non‐opioids. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication. Conclusions Possibly, opioids are associated with an increased all‐cause mortality risk compared to non‐opioid analgesics. When considering treatment options for patients with CNCP, the possible risk of increased all‐cause mortality with opioids should be discussed. Significance An increased all‐cause mortality associated with opioid use compared to non‐opioid analgesics for CNCP was identified by a systematic review of four propensity score matched cohort studies in real‐world settings. The number needed to harm for an additional excess death per 10,000 person‐years was 116. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication. The potential risk of increased all‐cause mortality with opioids should be discussed with patients when considering opioid treatment.

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“…Opioids were associated with less pain relief during longer trials possibly due to opioid tolerance or opioid induced hyperalgesia 118 . The European clinical practice recommendations on opioids for chronic noncancer pain recently suggested to first optimize established non-pharmacological treatments and non-opioid analgesics and only thereafter to consider opioid treatment if established non-pharmacological treatments or nonopioid analgesics are not effective and/or not tolerated and/or contraindicated 119 . In a retrospective population-based cohort study, adverse outcomes were more common among patients with polyneuropathy (68% with diabetes) receiving long-term (≥90 days) compared with short-term (<90 days) opioid therapy, including depression, impaired functional status, opioid dependence, and opioid overdose, 120 supporting a limitation of treatment duration for opioids to 3 months whenever possible.…”

Section: Opioidsmentioning

confidence: 99%

Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations

Ziegler

Tesfaye

Spallone

et al. 2022

Diabetes Research and Clinical Practice

103

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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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

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 77 publications

References 74 publications

Is Europe also facing an opioid crisis?—A survey of European Pain Federation chapters

Is Europe also facing an opioid crisis?—A survey of European Pain Federation chapters

Is opioid therapy for chronic non‐cancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations

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