Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines, 2020, Petzke et al

[Andy]

Introduction:
The opioid epidemic in North America challenges national guidelines worldwide to define the importance of opioids for the management of chronic noncancer pain (CNCP).

Methods:
The second update of the German guidelines on long-term opioid therapy for CNCP was developed by 26 scientific associations and 2 patient self-help organizations. A systematic literature search in CENTRAL, Medline, and Scopus (to May 2019) was performed. Meta-analyses of randomized controlled trials and open-label extension studies with opioids for CNCP were conducted. Levels of evidence were assigned according to the Oxford Centre for Evidence-Based Medicine classification system. The formulation and strength of recommendations were established by multistep formalized procedures to reach a consensus according to German Association of the Medical Scientific Societies regulations. The guidelines underwent external review by 4 experts and public commentary.

Results:
Opioids are one drug-based treatment option for short- (4–12 weeks), intermediate- (13–26 weeks), and long-term (>26 weeks) therapy of chronic pain in osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia, and low back pain. Contraindications are primary headaches, functional somatic syndromes, and mental disorders with the (cardinal) symptom of pain. For specified other clinical pain conditions, short- and long-term therapy with opioids should be evaluated on an individual basis. Long-term therapy with opioids is associated with relevant risks.

Conclusion:
Responsible application of opioids requires consideration of possible indications and contraindications, as well as regular assessment of clinical response and adverse effects. Neither uncritical opioid prescription nor general rejection of opioids is justified in patients with CNCP.

Open access, https://journals.lww.com/painrpts/F...m_opioid_therapy_for_chronic_noncancer.3.aspx

Posted particularly for this bit (my bolding)

The recommendations against use of opioids for primary headache and inflammatory bowel disease were based on cohort studies indicating increased risks of opioid therapy (Table 3). The recommendation against opioids for chronic pancreatitis pain was based on a negative RCT assessing opioid use. In addition, the negative recommendations for primary headache, irritable bowel syndrome, fibromyalgia syndrome, and somatoform disorders were in accordance with current German guidelines specifically addressing these diseases.

 

[alktipping]

so where did these people get actual evidence of so called somatoform disorders or are they giving somatoform a different meaning from the bps version .

 

[MEMarge]

Skimming through the paper it does not seem to look at low dose opiate patches, which can be very effective for long-term chronic pain, according to the pain clinic consultant.

These include patches, which release 5 microgram/hr of buprenorphine, over 7 days.

 

[Mithriel]

Contraindications are primary headaches, functional somatic syndromes, and mental disorders with the (cardinal) symptom of pain.

So you can be condemned to a life time of agony because you have a doctor who is overly influenced by BPS theories?

Pain drugs should be given by need and whether they relieve pain. People who have severe pain should be prioritised over people who abuse drugs.

They are seeing minimising the risk to people who take massive doses of these drugs as a higher good than the quality of life of sick people and the risk of suicides among them.

There must be a better way of helping drug addicts than making other people suffer. It makes you wonder if it is just a lip service answer. Cut done on the cost of pain prescriptions and don't set up services for addicts or address any of the social problems which can lead to addiction.