Empfehlungen der zweiten Aktualisierung der Leitlinie LONTS

Abstract

Recommendations of the second update of the LONTS guidelines. Long-term opioid therapy for chronic noncancer pain Abstract Background. The second scheduled update of the German S3 guidelines on long-term opioid therapy for chronic noncancer pain (CNCP), the LONTS (AWMF registration number 145/003), was started in December 2018. Methods. The guidelines were developed by 28 scientific societies and 2 patient self-help organizations under the coordination of the German Pain Society. A systematic literature search in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Scopus databases (up until December 2018) was performed. The systematic reviews with meta-analyses of randomized controlled trials with opioids for CNCP from the previous versions of the guideline were updated. Levels of evidence were assigned according to the classification system of the Oxford Centre

The burden of chronic pain for patients with osteoarthritis in Germany: a retrospective cohort study of claims data

“…German guidelines on the treatment of hip and knee OA recommend opioid therapy for short durations only; for example, as bridging therapy prior to joint replacement surgery [13,14]. The German guidelines on the long-term use of opioids in non-cancer pain suggest that use in OA should be limited to situations where joint replacement surgery is not possible/ not wanted and where other pharmacological/non-pharmacological therapies are unsuitable/ineffective [15]. Together, these guidelines suggest that there are limited situations where opioids are recommended for the treatment of OA; however, our findings demonstrate that a significant proportion of patients with OA are receiving opioid prescriptions in Germany.…”

“…Recommendations for pharmacological therapies in international treatment guidelines for hip and knee OA have subtly evolved over time, generally moving away from paracetamol (acetaminophen) and more clearly defining the situations where opioids might be appropriate [8][9][10][11][12]. This is also the case in German treatment guidelines [13][14][15]. Joint replacement is generally considered when pain and structural damage becomes intolerably limiting for a patient and cannot be effectively addressed by other therapies [13,14,[16][17][18].…”

“…Joint replacement is generally considered when pain and structural damage becomes intolerably limiting for a patient and cannot be effectively addressed by other therapies [13,14,[16][17][18]. In Germany, intolerable pain, loss of function, and structural joint damage evident on radiographs form the indications for joint replacement surgery [13][14][15]18]. Yet, invasive joint surgery has inevitable risks and drawbacks, and is not appropriate for all patients, since for some, surgery involves lengthy recovery or can be associated with a risk of persistent post-surgical pain (~9% after hip replacement and 20% after knee replacement) [19].…”

Kritische Auseinandersetzung mit neuen Daten zur Prävalenz von Opioidgebrauchsstörungen bei Patienten mit chronischen Schmerzen in Deutschland

“…In der aktualisierten Leitlinie zur Langzeitanwendung von Opioiden bei chronischen nichttumorbedingten Schmerzen (LONTS) besteht Konsens, dass es in Deutschland keinen opioidbezogenen Gesundheitsnotstand ("Opioidkrise" oder "Opioidepidemie") wie in den USA gibt [11]. In den letzten Jahren sind jedoch mehrere Studien einer deutschen Arbeitsgruppe erschienen, welche die Häufigkeit einer Opioidgebrauchsstörung sowie das Risiko von Opioidmissbrauch bei Patienten mit chronischen Schmerzen untersuchten, jedoch in der aktuellen LONTS-Leitlinie nicht berücksichtigt wurden [13,15,16].…”

Risikostratifizierung in der Rheumatologie: Analgetika-Therapie

“…Trotz (moderat) steigender Verordnungszahlen ist in Deutschland eine derartige dramatische Entwicklung zwar derzeit nicht zu sehen, dies erfordert aber auch weiterhin einen kritischen Einsatz dieser Präparate unter Vermeidung von Über-und Fehltherapie. Sehr hilfreich für die tägliche praktische Tätigkeit ist hierfür die S3-Leitlinie "Langzeitanwendung von Opioiden bei nichttumorbedingten Schmerzen" in ihrer aktualisierten Form von 2020 (LONTS3), auf die hier im Wesentlichen Bezug genommen wird [21].…”