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 for Evidence-Based Medicine. The strength of the recommendations was established by formal multistep procedures in order to reach a consensus according to the Association of the Medical Scientific Societies in Germany (AWMF) regulations. The guidelines were reviewed by four external pain physicians. Public comments were possible for 4 weeks. RESULTS Opioid-based analgesics are a drug-based treatment option for short-term (4-12 weeks), intermediate-term (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. Based on a clinical consensus the guidelines list other medical conditions for which a therapy with opioids can be considered on an individual basis. Long-term therapy of CNCP with opioids is associated with relevant risks. CONCLUSION A responsible administration of opioids requires consideration of possible indications and contraindications as well as regular assessment of efficacy and adverse effects. Opioids remain a treatment option for CNCP if nonpharmacological therapies are not effective and/or other drugs are not effective, are not tolerated or are contraindicated.

中文翻译：

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Empfehlungen der zweiten Aktualisierung der Leitlinie LONTS

背景：德国 S3 长期阿片类药物治疗慢性非癌性疼痛 (CNCP) 指南的第二次预定更新 LONTS（AWMF 注册号 145/003）于 2018 年 12 月开始。方法 该指南由 28 个科学学会制定德国疼痛协会协调下的 2 个患者自助组织。在 Cochrane 对照试验中央注册库 (CENTRAL)、MEDLINE 和 Scopus 数据库（截至 2018 年 12 月）中进行了系统的文献检索。更新了先前版本指南中对用于 CNCP 的阿片类药物随机对照试验的荟萃分析的系统评价。根据牛津循证医学中心的分类系统分配证据级别。建议的强度是通过正式的多步骤程序确定的，以便根据德国医学科学协会 (AWMF) 的规定达成共识。该指南由四位外部疼痛医师审查。公众可以在 4 周内发表意见。结果 阿片类镇痛药是一种基于药物的治疗选择，用于慢性骨关节炎、糖尿病性多发性神经病、带状疱疹后遗症的短期（4-12 周）、中期（13-25 周）和长期（≥26 周）治疗。神经痛和腰痛。禁忌症是原发性头痛以及具有（主要）症状疼痛的功能性躯体综合征和精神障碍。根据临床共识，该指南列出了可以根据个人情况考虑使用阿片类药物治疗的其他医学病症。用阿片类药物长期治疗 CNCP 与相关风险相关。结论 负责任地使用阿片类药物需要考虑可能的适应症和禁忌症，并定期评估疗效和副作用。如果非药物疗法无效和/或其他药物无效、不耐受或禁忌，阿片类药物仍然是 CNCP 的治疗选择。