Table 3.

Contraindications for opioids.

Medical condition	Level of evidence (Oxford)	Strength of recommendation	Strength of consensus
Primary headache	3b	Strong against	Strong
Functional disorders (eg, fibromyalgia syndrome*, irritable bowel syndrome)	5	Strong against	Strong
Chronic pain as a major manifestation of a mental disorder (atypical depression, persistent somatoform pain disorder, generalized anxiety disorder, and posttraumatic stress disorder)	5	Strong against	Consensus
Chronic pancreatitis†	2b	Against	Strong
Chronic inflammatory bowel disease†	3b	Against	Strong
Comorbid severe affective disorder and/or suicidality	5	Strong against	Strong
Current medication abuse or passing on of medications to unauthorized persons, and/or serious doubt concerning responsible use of opioid analgesics (eg, uncontrolled taking of medications and/or unwillingness or inability to adhere to the dosing schedule)	5	Strong against	Strong
Current or planned pregnancy	5	Strong against	Strong

^*Except tramadol for fibromyalgia syndrome (minority vote of the German Association of Rheumatology, and the German Pain Society).

^†Treatment for a limited time (<4 weeks) is possible during an acute episode.