Opioid Use for Acute Pain Was Typically Low Dose and Short Duration, but Leftover Medication Remained Common

According to emerging data published in JAMA Network Open, a vast majority of opioid-naive patients who were offered an opioid prescription for acute pain used opioids at low doses and for short durations, although some patients reported prolonged use and most had leftover medication.

The study, referred to as the Acute Pain Pathways study (NCT04509115), had enrolled 1708 opioid-naive patients with acute pain across 5 US health systems between September 2020 and March 2023. The patients were recruited from emergency departments (EDs), primary or urgent care clinics, dental practices, and inpatient settings following cesarean delivery or knee replacement. The study was designed in collaboration with and supported by the FDA to help address evidence gaps in acute pain management and opioid prescribing across everyday clinical settings.¹

Pain Resolution Varied by Pain Source

Among 1502 patients enrolled who reported pain severity on at least 1 daily survey, the median time to pain resolution was 20 days (IQR, 8-88 days). However, pain duration varied substantially by source. Patients with postsurgical pain had the longest time to resolution, with a median of 74 days (IQR, 30 days to not reached), whereas patients with kidney stones had the shortest time to resolution, with a median of 8 days (IQR, 2-17 days).¹

Low back pain was also found in association with longer duration. Among patients with low back pain, the median time to pain resolution was 69 days (IQR, 18 days to not reached). For some pain conditions, including low back pain, more than 25% of patients had not experienced pain resolution by the time they were censored because of loss to follow-up or the end of the study period.¹

These findings indicate that acute pain may persist longer than expected for certain conditions, even among patients initially treated in outpatient or postdischarge settings. However, the data noted that daily pain reports captured any pain rather than only pain related to the acute episode, and nearly one-third of patients reported having pain most days or every day during the 6 months before enrollment.¹

Opioid Use Was Common Early but Declined Over Time

During the first 15 days of follow-up, 1482 patients completed at least 1 survey reporting both daily pain and treatment use. Most patients used multiple treatment approaches, including opioids, nonopioid medications, and nonpharmacologic strategies.¹

Over the first 15 days, 1153 patients (77.8%) reported using opioids at least once, and 1287 patients (86.8%) reported using acetaminophen or ibuprofen at least once. Nonpharmacologic strategies were also common: 1375 patients (92.8%) reported resting or staying home, and 952 patients (64.2%) reported supportive measures such as heat, ice, braces, or wraps. Mindfulness, prayer, or distraction techniques were reported by 184 patients (12.4%).¹

Opioid use was highest on days when patients reported the most severe pain. Opioid use peaked on the second day of follow-up, when 524 of 916 survey respondents (57.2%) reported opioid use, then declined to 138 of 861 respondents (16.0%) by day 14.¹

Among patients who reported opioid use, the mean number of opioid tablets taken per day remained modest across the early follow-up period. On day 0, patients who used opioids took a mean of 2.04 tablets. Across days 0 through 14, the highest mean daily use was 2.35 tablets on day 13. In daily survey responses that included both the number and strength of tablets taken, the median daily dose was 10 morphine milligram equivalents (MME) (IQR, 5-15 MME).¹

Patients notably did not always use opioids even when pain was severe. Approximately one-third of patient-days with pain intensity rated 8 or higher out of 10 did not include opioid use.¹

Opioids Provided Modestly Greater Reported Relief

Among 1431 patients who reported treatment use and resulting relief on at least 1 of the first 15 days, reported relief was moderately greater on opioid-use days compared with days involving nonopioid or nonpharmacologic treatments. Mean adjusted pain relief was 60.6% on opioid-use days compared with 55.1% on nonopioid days, a difference of 5.5 percentage points.¹

In random-effects modeling, patients reported the greatest pain relief on days when they used opioids without other pharmaceutical treatments. Relief was lower on days when patients used opioids with nonopioid pharmaceuticals, nonopioid pharmaceuticals without opioids, or nonpharmacologic treatment. Patients with higher pain scores reported less relief from treatment overall.¹

While these findings suggest an incremental analgesic benefit with opioids, the magnitude of added relief was limited. The results may support current recommendations that emphasize nonopioid therapies as first-line options for many acute pain conditions, with opioids reserved for severe pain or pain that does not respond adequately to alternatives.^2,3

Some Patients Reported Prolonged Opioid Use

Among 1189 patients who reported any opioid use during follow-up, the median time to opioid discontinuation was 7 days (IQR, 2-31 days). Time to discontinuation varied by pain condition, with postsurgical patients reporting the longest opioid use at a median of 33 days (IQR, 11-59 days) and patients with abdominal pain reporting the shortest duration at a median of 3 days (IQR, 1-19 days).¹

An estimated 10.0% of patients used opioids for at least 90 days. Patients who reported frequent pain before enrollment were more likely to continue opioid use for at least 90 days. Among patients who reported any opioid use, 30.4% had pain most days or every day during the 6 months before receiving the opioid prescription, and this group had the highest estimated rate of opioid use lasting at least 90 days (15.5%). By contrast, patients who reported no pain in the prior 6 months had the lowest estimated rate of opioid use lasting at least 90 days (2.9%).¹

Leftover Opioids Were Common

Among 982 patients who responded to questions about remaining medication, 657 patients (66.9%) reported having leftover opioids. The proportion with leftover opioids varied by pain source, ranging from 52.8% among postsurgical patients to 75.8% among patients with kidney stones.¹

The high rate of leftover medication is clinically important because unused opioids may contribute to unsafe storage, accidental exposure, diversion, or later nonmedical use. Pharmacists can help mitigate these risks by counseling patients at dispensing on the expected duration of use, avoiding scheduled opioid use unless specifically directed, using nonopioid therapies when appropriate, storing opioids securely, and disposing of unused tablets through take-back programs or other recommended disposal options.

Among 519 patients who completed scorable Prescription Opioid Difficulties Scale questions during the first monthly survey, 115 patients (22.2%) reported experiencing at least 1 difficulty related to opioid use in the previous 30 days. The most common difficulties included feeling sleepy when needing to be alert and feeling sluggish or sedated.¹

Implications for Practice

This data is consistent with current guidance recommending multimodal acute pain management, use of nonopioid therapies when appropriate, and prescribing opioids only at the lowest effective dose and for no longer than needed.² The FDA has also emphasized that many acute pain conditions treated in outpatient settings require no more than a few days of opioid therapy and that immediate-release opioids should not be used for an extended period unless pain remains severe enough to require them and alternatives remain inadequate.³

The findings reinforce the importance of individualized counseling at the point of care. Patients should understand that some pain may persist beyond the initial visit and that complete pain elimination is not always a realistic or clinically appropriate goal. Instead, counseling can emphasize functional improvement, appropriate use of acetaminophen or nonsteroidal anti-inflammatory drugs when indicated, nonpharmacologic strategies such as ice or heat, and clear guidance on when opioid use may be appropriate. Although a short initial opioid prescription may meet the needs of many opioid-naive patients with acute pain, those with frequent preexisting pain, postsurgical pain, or low back pain may require closer follow-up and a more individualized pain management plan.

REFERENCES

1. Jeffery MM, Bellolio F, Chang N, et al. Opioid use and pain resolution for acute pain among opioid-naive patients. JAMA Netw Open. 2026;9(7). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2851283?guestAccessKey=1b34668e-afe8-4888-aa3d-dd05b3b83eff&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070726 doi:10.1001/jamanetworkopen.2026.21875

2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1

3. FDA approves safety labeling changes for opioid pain medicines. FDA. December 15, 2023. Accessed July 7, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-approves-safety-labeling-changes-opioid-pain-medicines