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

Research output: Contribution to journalArticlepeer-review

Nevenka Krcevski–Škvarc, Bart Morlion, Kevin E. Vowles, Kirsty Bannister, Eric Buchsner, 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, Winfried Häuser

Original languageEnglish
Pages (from-to)969-985
Number of pages17
JournalEuropean Journal of Pain (United Kingdom)
Volume25
Issue number5
DOIs
Accepted/In press2021
PublishedMay 2021

Bibliographical note

Publisher Copyright: © 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Background: Opioid use for chronic non-cancer pain (CNCP) is under debate. 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 European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). Conclusion: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. Significance: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.

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