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

Winfried Häuser, Bart Morlion, Kevin E Vowles, Kirsty Bannister, Eric Buchser, Roberto Casale, Chenot Jean-François, Gillian Chumbley, Asbjørn Mohr Drewes, Gert Dom, Liisa Jutila, Tony O'Brien, Esther Pogatzky-Zahn, Martin Ragusa, Carmen Suarez-Serrano, Thomas Tölle, Nevenka Krcevski-Škvarc

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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.

Original languageEnglish
Pages (from-to)949-968
Number of pages20
JournalEuropean Journal of Pain
Issue number5
Early online date02 Mar 2021
Publication statusEarly online date - 02 Mar 2021


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