Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines

Petzke, Frank; Bock, Frietjof; Hüppe, Michael; Nothacker, Monika; Norda, Heike; Radbruch, Lukas; Schiltenwolf, Marcus; Schüler, Matthias; Tölle, Thomas R.; Viniol, Anika; Haüser, Winfried

doi:10.1097/pr9.0000000000000840

Cited by 21 publications

(26 citation statements)

References 37 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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“…Opioids can be an important tool in the management of chronic pain. However, the experience of recent years has shown that benefit and harm in treatment of non-cancer pain can be closely related, and that opioid consumption is influenced by different factors [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Opioid use is associated with statistically significant but small improvements in pain and physical functioning [9]. Numerous studies exist demonstrating that psychological comorbidities such as depression and anxiety are prevalent among patients with chronic non-cancer pain [3,6], and that these patients are more likely to receive long-term opioid therapy for pain [4]. A proposed reason for this phenomenon is that mental health conditions and chronic non-cancer pain are closely correlated concerning severity [5].…”

Section: Introductionmentioning

confidence: 99%

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

Kleinmann

Wolter

2022

JCM

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Background: Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake. Methods: At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients’ charts. Results: Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education. Conclusions: Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.

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“…These include strong opioids (SO), whose consumption has increased in recent years in our setting [4,5], mostly in patients with chronic non-cancer pain (CNCP). This indication lacks evidence and has a high risk of adverse effects, leading guidelines to recommend limiting their use to very specific cases, after assessing the risk-benefit [6][7][8][9]. The risk increases with some factors such as age, comorbidity and concomitant prescription of some other drugs.…”

Section: Introductionmentioning

confidence: 99%

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

Bratescu

Dürsteler

Álvarez-Carrera

et al. 2022

IJERPH

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The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged ≥15 years with a continued SO prescription for ≥3 months during 2013–2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications.

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Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines

Abstract: Supplemental Digital Content is Available in the Text. Neither uncritical opioid prescription nor general rejection of opioids is justified in patients with chronic noncancer pain. Responsible application requires consideration of indications, contraindications, and regular assessment.

Cited by 21 publications

References 37 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

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

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