European clinical practice recommendations on opioids for chronic noncancer pain – Part 2: Special situations*

Abstract

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System-level policies on appropriate opioid use, a multi-stakeholder consensus

“…The widespread use of opioids and its association with premature mortality demonstrate that this is a major public health issue. Guidelines, mostly at the intention of prescribers have been developed, for instance in the UK, as there is a need to develop consistent evidence on effective and safe prescription strategies [ 3 , 28 , 36 – 38 ]. But evidence is lacking regarding the effect, at the system level, of policies on prescriptions and the different strategies adopted internationally.…”

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

“…Education of patients and health care professionals on appropriate use of opioids for acute, cancer and noncancer pain should be provided by medical associations and training courses. EFIC has published clinical practice recommendations on the (limited) role of opioids for and their appropriate use in CNCP (Häuser et al., 2021; Krcevski‐Škvarc et al 2021).…”

Bioequivalence, Drugs with Narrow Therapeutic Index and the Phenomenon of Biocreep: A Critical Analysis of the System for Generic Substitution

“…Opioids are usually used to treat acute pain related to trauma, diagnostic and surgical procedures, and other acute medical problems; moreover, they are also used for the treatment of moderate and severe chronic pain, in cancer and noncancer patients with no adequate response to nonopioid drugs [ 64 , 65 , 66 ]. Chronic pain is a complex disease entity with a major impact on healthcare costs that results from a maladaptive functional and structural transformation process, sustained by mechanisms of peripheral and central sensitization involving altered neuronal activity [ 67 ].…”

“…Opioid therapy produces a spectrum of adverse effects including sedation, hypotension, and respiratory depression linked to the analgesic effect and have abuse potential that has been recently reconsidered [ 66 , 72 , 73 ]. Primary causes of unwanted clinical effects observed with opioid prescriptions are improper use by the patient or improper prescription by clinicians [ 66 , 74 ].…”