title: [Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain].
abstract: BACKGROUND
  The regular update of the German S3 guidelines on long-term opioid therapy for chronic noncancer pain (CNCP), the"LONTS" (AWMF registration number 145/003), began in November 2013.
  
  
  METHODS
  The guidelines were developed by 26 scientific societies and two patient self-help organisations under the coordination of the Deutsche Schmerzgesellschaft (German Pain Society). A systematic literature search in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Scopus databases (up until October 2013) was performed. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of the recommendations was established by multistep formal procedures, in order to reach a consensus according to German Association of the Medical Scientific Societies ("Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften", AWMF) regulations. The guidelines were reviewed by the Drug Commission of the German Medical Association, the Austrian Pain Society and the Swiss Association for the Study of Pain.
  
  
  RESULTS
  Opioids are one drug-based treatment option for short- (4-12 weeks), intermediate- (13-25 weeks) and long-term (≥ 26 weeks) therapy of chronic osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia and low back pain. Contraindications are primary headaches, as well as functional somatic syndromes and mental disorders with the (cardinal) symptom pain. For all other clinical presentations, a short- and long-term therapy with opioid-containing analgesics should be evaluated on an individual basis. Long-term therapy with opioid-containing analgesics is associated with relevant risks (sexual disorders, increased mortality).
  
  
  CONCLUSIONS
  Responsible application of opioid-containing analgesics requires consideration of possible indications and contraindications, as well as regular assessment of efficacy and adverse effects. Neither an uncritical increase in opioid application, nor the global rejection of opioid-containing analgesics is justified in patients with CNCP.
authors.affiliation: Medizinisches Versorgungszentrum (Schmerztherapie, Palliativmedizin, Psychiatrie, Psychotherapie) Saarbrücken - St. Johann, Saarbrücken, Deutschland, whaeuser@klinikum-saarbruecken.de.
authors.forename: W
authors.initials: W
authors.lastname: Häuser
authors.forename: F
authors.initials: F
authors.lastname: Bock
authors.forename: P
authors.initials: P
authors.lastname: Engeser
authors.forename: G
authors.initials: G
authors.lastname: Hege-Scheuing
authors.forename: M
authors.initials: M
authors.lastname: Hüppe
authors.forename: G
authors.initials: G
authors.lastname: Lindena
authors.forename: C
authors.initials: C
authors.lastname: Maier
authors.forename: H
authors.initials: H
authors.lastname: Norda
authors.forename: L
authors.initials: L
authors.lastname: Radbruch
authors.forename: R
authors.initials: R
authors.lastname: Sabatowski
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.forename: M
authors.initials: M
authors.lastname: Schiltenwolf
authors.forename: M
authors.initials: M
authors.lastname: Schuler
authors.forename: H
authors.initials: H
authors.lastname: Sorgatz
authors.forename: T
authors.initials: T
authors.lastname: Tölle
authors.forename: A
authors.initials: A
authors.lastname: Willweber-Strumpf
authors.forename: F
authors.initials: F
authors.lastname: Petzke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D032921:Consensus; D018849:Controlled Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D057970:Inappropriate Prescribing; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D017410:Practice Guidelines as Topic; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid