[Acceptance of recommendations and guidelines for pain therapy with opioids]

The practical impact of guidelines for long-acting opioids is estimated to be low. This is not solely due to their quality or kind of implementation. Their core problem is to build a consensus across contradicting facts which resulted until recently in somewhat ambiguous recommendations. Coming guidelines on pain management with the aid of opioids should better connect controversial positions and analyze upcoming paradoxes: while analgesic or adverse long-term effects are still unproven for all opioids the consumption is rising, but severe pain remains often inadequately managed. The article analyses some of those paradoxes and gives propositions for guidelines, which may lead to their better practical acceptance.