Empfehlungen der zweiten Aktualisierung der Leitlinie LONTS: Langzeitanwendung von Opioiden bei chronischen nicht-tumorbedingten Schmerzen

Translated title of the contribution: Recommendations of the second update of the LONTS guidelines: Long-term opioid therapy for chronic noncancer pain

Winfried Häuser, Frietjof Bock, Michael Hüppe, Monika Nothacker, Heike Norda, Lukas Radbruch, Marcus Schiltenwolf, Matthias Schuler, Thomas Tölle, Annika Viniol, Frank Petzke, Karl Jürgen Bär, Christoph Baerwald, Matthias Beintker, Jens Büntzel, Corinna Elling-Audersch, Stephan Freys, Irmela Gnass, Ursula Havemann-Reinecke, Kirstin HupferUlrich Kellner, Claas Lahmann, Martin Marziniak, Gerhard Müller, Holger Petri, Achim Rody, Michael Schäfer, Dietmar Schöffel, Volker Thieme, Volker Tronnier, Dirk Wolter, Dan Ziegler

4 Citations (Scopus)


© 2020, Springer Medizin Verlag GmbH, ein Teil von Springer Nature. 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.
Translated title of the contributionRecommendations of the second update of the LONTS guidelines: Long-term opioid therapy for chronic noncancer pain
Original languageGerman
Issue number3
Pages (from-to)204-244
Number of pages41
Publication statusPublished - 01.06.2020

Research Areas and Centers

  • Centers: University Cancer Center Schleswig-Holstein (UCCSH)


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