title: [Opioids for chronic noncancer pain: recommendations based on clinical practice guidelines].
abstract: OBJECTIVE
  The need for major opioids in the treatment of chronic pain unrelated to cancer is increasing. We therefore appraised available clinical practice guidelines in order to identify recommendations for good practice in the use of these drugs.
  
  
  METHODS
  By searching the main guideline repositories as well as resources provided by medical associations, we identified clinical practice guidelines on the use of major opioids published up to 2007. Fourteen of the 28 guidelines we found met the inclusion criteria. To appraise the guidelines we applied the criteria for scientific evidence of the AGREE collaboration (Appraisal of Guidelines Research and Evaluation). The AGREE instrument consists of 23 items organized in 6 areas for appraisal.
  
  
  RESULTS
  Of the 14 guidelines appraised, 5 were judged to be of high quality. In each of the 5 selected guidelines, the relation between a recommendation and the evidence it was based on was stated explicitly; all 5 had overall quality scores over 60%. The recommendations drawn from these guidelines deal with 3 sequential moments in the use of opioids: start of treatment, maintenance therapy, and withdrawal of the drug.
  
  
  CONCLUSIONS
  The use of opioids to treat chronic noncancer pain is controversial in terms of effectiveness, safety, and the possibility of addiction or abuse. The opioid should be indicated for the pain and prescribed with caution; each case should be assessed individually. Following the recommendations drawn from these guidelines will be important for achieving control of both pain and the accompanying symptoms. The use of major opioids to relieve chronic pain unrelated to cancer, and therefore to improve the quality of life of patients who experience this type of pain, is a legitimate treatment approach.
authors.affiliation: Clínica del Dolor, Servicio de Anestesiología, Hospital Universitario de la Santa Creu y Sant Pau, Barcelona. ecatala@santpau.cat
authors.forename: E
authors.initials: E
authors.lastname: Català
authors.forename: M
authors.initials: M
authors.lastname: Ferrándiz
authors.forename: L
authors.initials: L
authors.lastname: Lorente
authors.forename: Z
authors.initials: Z
authors.lastname: Landaluce
authors.forename: M
authors.initials: M
authors.lastname: Genové
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid