Findings of study Indicate Multimodal Analgesia and Brief Opioid Use Are Norm for Acute Pain

How long do opioid-naive patients really need opioids for acute pain-and how much do they actually use? In the largest prospective cohort of its kind, researchers tracked real-world opioid and nonopioid use, pain resolution, and leftover medication among more than 1,700 U.S. adults prescribed opioids for acute pain.

Study Design: Diverse, Multicenter Cohort Across Common Acute Pain Settings

This prospective study enrolled 1,708 opioid-naive patients from five health systems (ED, primary care, dental, and inpatient settings) between 2020 and 2023. Participants were offered an opioid prescription for acute pain and completed digital surveys about pain level, treatment use, and outcomes for up to six months. Pain sources ranged from dental and trauma to surgical, obstetric, and musculoskeletal complaints.

Key Findings: Most Opioid Use Is Brief—and Many Patients Have Leftovers

Median pain resolution: 20 days (IQR, 8–88), but surgical and low back pain lasted much longer (medians 74 and 69 days, respectively).

Opioid use: Most patients (78%) reported using an opioid at least once, but use was generally short-term—median time to discontinuation was 7 days. Only 10% used opioids for 90 days or longer.

Doses were low: Median daily dose in the first two weeks was just 10 morphine milligram equivalents (MME).

Leftover opioids: A striking 67% of patients reported leftover medication, highlighting ongoing concerns about excess supply.

Multimodal Analgesia and Modest Pain Relief

Most patients used a combination of treatments, including nonopioid medications (acetaminophen, ibuprofen) and nonpharmacologic strategies (rest, ice, heat). Opioid use was more likely on days with severe pain, but even then, about a third of patients chose not to take opioids. On average, pain relief was modestly higher (about 5 percentage points) on opioid-use days versus nonopioid days.

Clinical Implications: Personalize and Limit Prescribing

The findings reinforce guidelines recommending short-duration, low-dose opioid prescribing for acute pain, with an emphasis on multimodal therapy. However, some patients—especially those with frequent pain before injury or surgery—required longer opioid courses. Clinicians should tailor therapy to individual needs, counsel about leftover medication disposal, and avoid overprescribing.

Conclusion

Short-term, low-dose opioid use is the norm for most opioid-naive patients with acute pain, and pain usually resolves in under a month. Multimodal therapies are common, and leftover opioids remain a challenge. Individualized care, education, and stewardship are essential to optimize pain management and minimize risk.

Key points

Most opioid-naive patients use opioids for a median of 7 days after acute pain, at low daily doses.

Only about 1 in 10 continue opioids for 90 days or more, often those with prior frequent pain.

Pain typically resolves within 20 days, but postsurgical and back pain last longer.

Multimodal analgesia is common, and most patients also use acetaminophen/ibuprofen and nonpharmacologic approaches.

Two-thirds of patients report leftover opioids, underscoring the need for careful prescribing and disposal counseling.

Citation:

Jeffery MM, Bellolio F, Chang N, et al. Opioid Use and Pain Resolution for Acute Pain Among Opioid-Naive Patients. JAMA Network Open. 2026;9(7):e2621875. doi:10.1001/jamanetworkopen.2026.21875