European clinical practice recommendations on opioids for chronic noncancer pain – Part 2: Special situations*
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 sci entific societies a...
| Authors: | , , , , , , , |
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| Format: | article |
| Status: | Published version |
| Publication Date: | 2021 |
| Country: | España |
| Institution: | Universidad de Sevilla (US) |
| Repository: | idUS. Depósito de Investigación de la Universidad de Sevilla |
| OAI Identifier: | oai:idus.us.es:11441/170348 |
| Online Access: | https://hdl.handle.net/11441/170348 https://doi.org/10.1002/ejp.1744 |
| Access Level: | Open access |
| Keyword: | Clinical practice Opioids Chronic noncancer pain Special situations |
| Summary: | 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 sci entific societies and one patient self- help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was per formed. 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 experi ence). 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 psychol ogy) 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 com bination with other medications, the management of frequent (e.g. nausea, constipa tion) 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 pa tient 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 pa tient group and/or clinical situation and to manage side effects effectively. A collabo ration of medical specialties and of all health care professionals is needed for some special populations and clinical situations. |
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