Guideline recommendations and everyday medical practice from the physician perspective: Survey among physicians on the use of opioid analgesics in the long-term treatment for chronic non-cancer pain

Z Evid Fortbild Qual Gesundhwes. 2026 Feb 23:S1865-9217(26)00002-4. doi: 10.1016/j.zefq.2026.01.001. Online ahead of print.

ABSTRACT

BACKGROUND: Germany is among the countries with the highest per capita consumption of opioid analgesics, which are mostly applied for chronic non-cancer pain (CNCP). The high-quality guideline LONTS, which is not disease-specific, gives treatment recommendations for long-term opioid therapy. Our aim was to explore physicians' knowledge of and their attitude towards this guideline, as well as their perception of the guideline's impact.

METHODS: A cross-sectional survey was conducted in September 2021 and a reminder sent out in January 2022. A standardized questionnaire was circulated among 1,854 physicians working in outpatient healthcare. The sample consisted of a random sample of primary care physicians, orthopedists, and neurologists from the pool of an address provider (n = 1,300), as well as the members of the Professional Association of Physicians and Psychological Psychotherapists in Pain and Palliative Medicine in Germany ("Berufsverband der Ärzte und Psychologischen Psychotherapeuten in der Schmerz- und Palliativmedizin in Deutschland", BVSD) (n = 554).

RESULTS: The questionnaire was completed by 422 physicians. The majority of physicians was older than 50 years (79%) and male (64%). One third of the participating physicians were primary care physicians (33%), 46% were anesthetists. A majority of the participants knew the LONTS guideline (83%). Their attitude towards following the LONTS guideline recommendations varied between "rare deviation in reasonable cases" (41%) and "regular deviation in reasonable cases" (52%). Though a majority of participating physicians (78%) thought that multimodal non-pharmaceutical treatment, as recommended by the LONTS guideline, is important, only 17% regarded it as being implementable.

DISCUSSION: The level of knowledge and implementation of the LONTS guideline fell within the range of other guidelines. The recommendation for multimodal non-pharmaceutical treatment accompanying long-term opioid therapy was considered important but unrealistic in current healthcare practice.

PMID:41735093 | DOI:10.1016/j.zefq.2026.01.001