Executive summary of the guideline for prescribing opioid analgesics for chronic non-cancer pain (third edition) by the Japan Society of Pain Clinicians
Japan Society of Pain Clinicians · 2025 · Japan
Source and licence
- Authors
- Akifumi Kanai, Masako Iseki, Hiroki Iida et al.
- Title
- Executive summary of the guideline for prescribing opioid analgesics for chronic non-cancer pain (third edition) by the Japan Society of Pain Clinicians
- Journal
- Journal of Anesthesia, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12464052
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendations
- We suggest using a treatment consent form to establish an informed consent process for the use of opioid analgesics. This helps clarify expectations for both the patient and the physician and provides a clear understanding of the nature of opioid analgesic treatment, including endpoints, goals, and strategies for when treatment does not progress as intended.【2D】
Recommendation
- We strongly recommend ongoing measures such as laxatives throughout the treatment period with opioid analgesics.【1B】
- We strongly recommend the use of peripheral μ-opioid receptor antagonists for opioid-induced constipation that does not improve with general laxatives.【1B】
Summary statement
- Naldemedine is recommended for opioid-induced constipation that is resistant to laxatives, rather than no treatment. (Level of evidence: high, strength of recommendation: strong) Naloxegol is recommended for opioid-induced constipation that is resistant to laxatives, rather than no treatment. (Level of evidence: moderate, strength of recommendation: strong) Methyl-naltrexone is recommended for opioid-induced constipation that is resistant to laxatives, rather than no treatment.Level of evidence: low, strength of recommendation: conditional
- Peripheral μ-opioid receptor antagonists have a motor-promoting effect via antagonism of the inhibitory effect of μ-opioid analgesics on gastrointestinal motility. They are effective for the management of opioid-induced constipation.Level of evidence: high, strength of recommendation: strong
- Conditional use of peripheral μ-opioid receptor antagonists is recommended in cancer patients with opioid-induced constipation.Level of evidence: moderate, strength of recommendation: weak
- In patients with opioid-induced constipation, peripheral μ-opioid receptor antagonists should always be considered. (Level of evidence: strong, recommendation: recommended for cancer patients) ・In patients with opioid-induced constipation that is not responsive to peripheral μ-opioid receptor antagonists, consider adding another laxative. (Level of evidence: low, recommendation: suggestion) Laxatives (or peripheral μ-opioid receptor antagonists) should always be prescribed for patients receiving opioid analgesics.Level of evidence: low, recommendation: suggested
- For patients with suspected opioid-induced constipation, osmotic laxatives, stimulant laxatives, naldemedine, or lubiprostone is effective. However, the choice of laxative should be considered in light of the individual patient's condition, taking into account factors such as safety, cost, and type of opioid being administered.Level of evidence: low; recommendation: none
- The use of peripheral μ-opioid receptor antagonists is recommended for opioid-induced constipation that does not improve with general laxatives.Level of evidence: B, recommendation level: 1
Recommendation
- We weakly recommend the use of weak opioid analgesics for patients with OA with severe pain when non-opioid analgesics are ineffective or contraindicated.2B
- We weakly recommend the use of opioid analgesics for herpes zoster-related pain.2D
- We weakly recommend the use of tramadol for PHN.2C
- We weakly recommend the use of strong opioid analgesics for PHN.2D
- We weakly recommend the use of tramadol for PDN.2D
Abstract
Opioid analgesics are powerful pain relievers, but inappropriate use can cause a variety of problems. Especially, in chronic non-cancer pain, inappropriate use of opioid analgesics might fail to improve or even worsen the quality of life and activities of daily living of patients impaired by pain. The Japan Society of Pain Clinicians has developed the Guidelines for Prescribing Opioid Analgesics for Chronic Non-cancer Pain (Third Edition), which answers basic clinical questions concerning opioid management as summary statements in accordance with the most recent scientific evidence and expert opinion. The guidelines emphasize patient selection (e.g., obvious organic cause of the persistent pain, low risk of psychosocial factors, pain refractory to non-opioid therapies, and good adherence to medication). Furthermore, patients should be treated with an oral dose of 90 morphine milligram equivalents/day as the upper limit and target duration of 3–6 months. For pain in cancer survivors that is not directly caused by cancer, such as pain after treatment or pain associated with complications or pre-existing conditions, these guidelines should be followed.
Contents of the original publication
The section headings of the original.
- Introduction
- Level of evidence
- Determining the level of recommendation
- Criteria for recommendations and consensus building
- Purpose of presenting this paper
- I. What are opioids?
- II. Opioid analgesics: specifics (Table 2)
- III. Treatment with opioid analgesics
- IV. Initiating treatment with opioid analgesics
- V. Side effects of opioid analgesics
- VI Discontinuation of treatment with opioid analgesics
- VII. Inappropriate use of opioid analgesics
- VIII. Indications for treatment with opioid analgesics
- IX. Prescription of opioid analgesics in special circumstances
- X. Other
- Summary of the guidelines
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