{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:36:52Z","timestamp":1785829012681,"version":"3.56.0"},"reference-count":57,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":118,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Research and Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Evidence\u2010based practice guidelines recommend combining the long\u2010term use of opioids for chronic noncancer pain (CNCP) with suitable nonpharmacologic treatments. Whether long\u2010term opioid therapy (LTOT) in Germany aligns with these recommendations is unknown so far. Therefore, our objective was to determine the use of nonpharmacologic treatments among patients receiving LTOT for CNCP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The retrospective observational analysis was based on administrative claims data of the German statutory health insurance fund\n                      <jats:italic>DAK-Gesundheit<\/jats:italic>\n                      . Patients with LTOT and no cancer diagnosis were selected between January 2018 and June 2019. The utilization of nonpharmacologic treatments, including physical therapy, psychotherapy, lifestyle modification, and other inpatient and outpatient treatments, was examined over a two\u2010year period. Subgroup analyses were conducted by age, preindex opioid prescriptions (\u2265\u20091\u2009year vs\u2009&lt;\u20091\u2009year), and the presence of ICD\u201010 diagnoses, including osteoarthritis, chronic back pain, inflammatory rheumatic diseases (excluding rheumatoid arthritis), neuropathy\/polyneuropathy, radiculopathy, and chronic pain disease. Additionally, regression analyses were performed to examine the association between diagnostic groups and the utilization of treatments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 113,476 patients met the inclusion criteria, of whom 25,945 (23%) did not utilize any of the defined nonpharmacologic treatments during the two\u2010year observation period. The most frequently utilized treatment was physical therapy (62%). Psychotherapy was used by 7% of patients, outpatient special pain therapy by 16%, whereas lifestyle modification (relaxation exercises and nutrition therapy) was used by fewer than 30 patients. Patients with \u2265\u20091\u2009year of opioid prescriptions prior to inclusion and elderly patients utilized most treatments less frequently. Over the 2\u2010year period, treatment provision remained largely constant, except for a steady decline in physical therapy for patients who had initiated opioid therapy more recently. Except for chronic pain disease, certain diagnoses were only weakly associated with treatment utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contrary to guideline recommendations, a notable proportion of LTOT patients may not receive pain management combining opioid therapy with nonpharmacologic treatments, particularly elderly patients and those with longer treatment duration. Future research should examine reasons for the low use of nonpharmacologic treatments.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial registration:<\/jats:bold>\n                      German Clinical Trials Register: DRKS00024854\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/prm\/2607538","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:26:19Z","timestamp":1777458379000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Large Retrospective Observational Study of Nonpharmacologic Treatment Use Among German Patients Receiving Long\u2010Term Opioid Therapy for Chronic Noncancer Pain"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8612-8096","authenticated-orcid":false,"given":"Nils Frederik","family":"Schrader","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Niemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Weitzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"Abels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Blase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"Riederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Nadstawek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Stra\u00dfmeir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Wasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-7005","authenticated-orcid":false,"given":"Silke","family":"Neusser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00482-010-1011-2"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00337-014-1152-y"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.36076\/ppj\/2015.18.E323"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269881120936544"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221153"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2559"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/bph.12634"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.1251"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18472"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1496"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7301.1511"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h444"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0035514"},{"key":"e_1_2_11_14_2","unstructured":"BeckerA.andStra\u00dfnerC. 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