title: Long-term opioid use in non-cancer pain.
abstract: BACKGROUND
  The long-term use of opioid analgesic drugs to treat chronic non-cancer pain (CNCP) is a major component of pain pharmacotherapy. The interpretation of the evidence concerning its efficacy and risks is currently debated.
  
  
  METHODS
  An interdisciplinary evidence- and consensus-based S3 guideline was updated on the basis of a systematic literature search (CENTRAL, Medline, and Scopus databases, from October 2008 to October 2013); meta-analyses of randomized controlled trials (≥ 4 weeks); and a consensus procedure, as specified by the AWMF regulations, including 22 medical and psychological societies and 2 patient self-help organizations.
  
  
  RESULTS
  119 publications were used to update the guideline, and 6 systematic reviews with meta-analyses were performed. A nominal group process was used to formulate recommendations concerning the indications and contraindications for the treatment of CNCP with opioid analgesics and the manner in which such treatments should be carried out. Opioid analgesics are an option for the short-term treatment (4-12 weeks) of chronic pain due to osteoarthritis (pain intensity, standardized mean difference [SMD]: -0.22 and -0.26), diabetic polyneuropathy (SMD -0.74), post-herpetic neuralgia (SMD -0.58), and chronic low back pain (SMD: -0.29 and -0.74). Long-term opioid treatment (≥ 26 weeks) for these diseases benefits only about 25% of patients. For other conditions, either short- or long-term treatment with opioid analgesics should be considered an individual therapeutic trial. Opioid treatment for pain is contraindicated by primary headaches and by any functional or mental disorder of which pain is a leading manifestation.
  
  
  CONCLUSIONS
  To minimize the risks of opioid analgesic treatment, physicians must be aware of its contraindications and must regularly reassess its efficacy and side effects. Pharmacotherapy should be combined with other types of treatment.
authors.affiliation: Department of Internal Medicine 1 and Medical Health Care Center (MVZ) Saarbrücken St. Johann, Saarbrücken, Orthopedic Center am grünen Turm, Grüner-Turm-Straße 4-10, Ravensburg, Primary care practice, Hohenzollernstraße 36, Pforzheim and Department of General Practice and Health Services Research at Heidelberg University, Heidelberg, Department of Neurology, Technische Universität München, Munich, Pain Day Hospital and Outpatient Clinic, University of Goettingen, Göttingen.
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
authors.forename: Fritjof
authors.initials: F
authors.lastname: Bock
authors.forename: Peter
authors.initials: P
authors.lastname: Engeser
authors.forename: Thomas
authors.initials: T
authors.lastname: Tölle
authors.forename: Anne
authors.initials: A
authors.lastname: Willweber-Strumpfe
authors.forename: Frank
authors.initials: F
authors.lastname: Petzke
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005858:Germany; D006261:Headache / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced* / Q000517:prevention & control; D009369:Neoplasms / Q000150:complications; D059408:Pain Management / Q000592:standards; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid