Letters to the Editor
The Complexity of Perioperative Opioid Therapy


With increasing awareness of pain as a problem of the first order and the foundation of pain societies in the 1970s, the underprovision of care for pain patients has been the subject of ongoing complaints. In many countries, especially in the US, the increased administration of opioids was massively advertised. In Germany, catchphrases such as “opioid phobia” or “morphine consumption as a measure/benchmark for the quality of pain treatment” (1) were used to drive up prescriptions. Klaus Kutzer, a retired judge at the Federal Court of Justice, started a trailblazing article with: “The consumption/use of morphine preparations for pain relief in incomparably higher in the Anglo-Saxon and Scandinavian countries than in the Federal Republic of Germany.” He pleaded for drawing fully on all therapeutic options in severe and extremely severe states of pain (2).
In the US, however, extremely serious misuse has developed within the drug scene and as a result of the overconsumption of prescribed opioids, with far in excess of 500 000 deaths since the 1990s, which is referred to as the opioid crisis. In the European Union (EU), especially in Germany, this undesirable development has not been observed—undoubtedly for various reasons—in particular, legal opioid prescriptions remained tightly controlled. The drug scene and medicine remained largely separate, which is certainly also a result of the thorough diagnostic evaluation in the context of pain treatment (3) and of responsible handling of opioids on the part of doctors.
The descriptive article (4) regarding persistent opioid use after surgery concluded, that the incidence in Germany is low. The fact that persistent opioid use after surgery occurs most commonly after amputations of the thigh or lower leg is, however, less likely to be associated with the type of surgery than rather with the subsequent phantom or stump pain, which can appropriately treated with opioid analgesics.
DOI: 10.3238/arztebl.m2025.0036
PD Dr. med. Roland Wörz
MA Medizinethik, Neurologe und Psychiater, Bad Schönborn
woerz.roland@t-online.de
1. | Illhardt FJ, Zenz M: In: Zenz Jurna (eds.): Lehrbuch der Schmerztherapie. Stuttgart: Wissenschaftl Verlagsges 2001; 217. |
2. | Kutzer K: Recht auf Schmerzbehandlung. Schmerz 1991; 5: 53–5 CrossRef MEDLINE |
3. | Wörz R: Schmerz in erweiterter Konzeption. Eine medizinische und erkenntnistheoretische Annäherung in der Lebenswelt. Schmerzmedizin 2023; 39(S3): 1–32 CrossRef |
4. | Dreiling J, Rose N, Arnold C, et al : The incidence and risk factors of persistent opioid use after surgery—a retrospective secondary data analysis. Dtsch Arztebl Int 2024; 121: 753–63 VOLLTEXT CrossRef PubMed Central |