Introduction: Opioid analgesia for acute painful conditions has come under increasing scrutiny with the public health crisis of opioid overdose, leading clinicians to seek nonopioid alternatives, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol).
Areas covered: This perspective evaluates recent clinical trials of nonopioids, opioids, and combination therapy for use in acute pain. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) often provide adequate analgesia, although these agents are not without risks. Combination therapy using a small amount of opioid together with a nonopioid pain reliever has been shown effective and reduces opioid consumption.
Expert opinion: The short-term use of opioids under close clinical supervision, such as in-hospital use of opioid analgesics for postoperative pain, may be appropriate, but even here, combination therapy or nonopioid therapy may be preferred. The use of opioids even for acute pain of short duration has been questioned. The ideal analgesic has yet to be developed, but effective pain control pharmacological regimens for acute pain are available.
Keywords: Acetaminophen; acetaminophen toxicity; acute pain; chronic pain; dental pain; dexketoprofen; gout; ibuprofen; ketamine; ketoprofen; ketorolac; meloxicam; migraine; morphine; multi-mechanistic pain; multimodal therapy; musculoskeletal pain; naproxen; nefopam; nonsteroidal anti-inflammatory drugs; opioid-associated side effects; opioids; patient-controlled analgesia; postsurgical pain; subacute pain; tapentadol.