Opioids for Mild/Moderate Pain

We recommend a multimodal approach to acute pain management, which prioritizes the use of multiple complementary strategies rather than relying solely on opioids. This includes nonpharmacologic methods (ice, elevation, splinting), non-opioid analgesics (acetaminophen, ibuprofen, ketorolac), and opioids when necessary.

Multimodal analgesia is a foundational principle in pain management. It involves combining two or more agents with different mechanisms of action to manage pain more effectively. This approach aligns with the biopsychosocial model of pain, aiming to reduce dependence on any single class of medication, particularly opioids. Evidence supports the idea that multimodal analgesia improves pain control, reduces opioid consumption, and minimizes opioid-related side effects. For example, a large-scale study involving over 1.5 million joint arthroplasty patients showed that adding one or more analgesic modalities to opioids led to incremental reductions in opioid use and associated side effects [3].

Treatment strategies should be tailored to the expected intensity and duration of pain, beginning with nonpharmacologic and non-opioid options. Opioids can then be introduced if clinically indicated for management of mild to moderate acute pain. For some cases of moderate and severe acute pain, opioids may be given concurrently with acetaminophen and ibuprofen or ketorolac.

Importantly, pain management should be individualized based on the cause of pain and patient-specific factors, including a discussion with the patient about the options available and the pros and cons of each. Patients should be educated that the goal is not complete elimination of pain but achieving a tolerable level that supports function and eventually recovery. Everyone has a different perception of pain including tolerance to it. If you have done a thorough event history, medical history, patient assessment, and tried non-opioid therapies but the patient is still uncomfortable, opioids should be re-considered.