A sweeping global review of opioid use for acute pain challenges long-standing assumptions about these widely prescribed drugs. Credit: Shutterstock

The largest review of its kind suggests opioids may offer far less relief for acute pain than commonly believed.

The largest analysis ever conducted on opioid pain medications used for acute pain has found that these drugs offer only modest, short-lived relief for certain conditions and do not work at all for others.

Researchers at the University of Sydney led the investigation, which examined both the benefits and risks of opioid pain relievers (e.g., codeine, morphine, oxycodone, tramadol) compared with a placebo in cases of acute pain.

The project brought together 59 systematic reviews spanning more than 50 different acute pain conditions in both children and adults. By compiling and evaluating this wide range of data, the team identified where opioids show measurable benefit and where evidence is weak or absent. According to the authors, this represents the most comprehensive and up-to-date assessment of when opioids are, and are not, effective for short-term pain.

The results were published in Drugs, a leading medical journal focused on pharmaceuticals.

“Opioids are among the most commonly prescribed treatments for acute pain, however, our review found that they did not provide large or lasting pain relief compared with placebo for the vast majority of acute pain conditions, with pain relief typically lasting only a few hours,” said lead author Associate Professor Christina Abdel Shaheed, from the School of Public Health at the University of Sydney.

“Overall, oral opioids were only slightly better than placebo for acute musculoskeletal pain, which they are often prescribed for, in the six to 48 hours after starting treatment. Opioids also increased the risk of side effects when used for acute musculoskeletal pain, some types of post-surgical pain, or traumatic limb pain.

“By showing that the benefits are generally small, short-lived, absent for many common conditions, and sometimes harmful, our research challenges the widely held belief that opioids are the most effective ‘go-to’ option for acute pain.”

Where Opioids Help — and Where They Don’t

Key findings of the systematic overview and meta-analysis:

• Opioids were associated with only modest, short-term pain relief for certain conditions, including stomach pain, dental surgery, ear procedures, traumatic limb pain, pain after childbirth, cesarean pain, and bunionectomy (bunion removal).
• For other conditions, opioids performed no better than placebo. These included some limb surgeries, kidney stone pain, pain after the removal of tonsils, and pain in newborns who require assisted breathing.
• Benefits were not consistent over time for heart-related pain, pain following hysterectomy (removal of a woman’s uterus), or the topical use of opioids (patches) for dermatological (skin) pain.
• Compared with placebo, opioids increased the likelihood of side effects when used for acute musculoskeletal pain, traumatic limb pain, and certain types of post-surgical pain. Reported side effects included nausea and vomiting.
• Although very short-term opioid use may reduce pain in some acute situations, ongoing use carries risks, including tolerance and dependence. More serious harms linked to opioids include misuse, overdose, hospitalization, and death.
• Because side effects were not consistently reported in many trials, the actual risks of these medications may be underestimated. The authors call for improved reporting of harms in clinical research and emphasize the need for safer and more effective alternatives.
• Overall, the findings do not support regular opioid use for acute pain. In addition, some studies examined only single doses, which may not reflect real-world prescribing and use.

Concerns over opioid use and misuse

“Persistent use of opioid medicines can develop quickly following first-time use (sometimes within days), and may arise from regular use for acute pain,” said co-first author Dr Stephanie Mathieson from the University of Sydney’s Institute for Musculoskeletal Health and School of Pharmacy.

“It is important that patients are informed about the potential harms from opioids when prescribed them, and that doctors prescribe these medicines judiciously (lowest effective dose for the smallest amount of time) for acute pain,” she said.

Co-first author Associate Professor Joshua Zadro from the University’s Institute for Musculoskeletal Health and School of Health Sciences added: “These findings are important for patients across all age groups who experience acute pain, doctors treating these conditions, and policy makers who regulate the safe use of these medicines in the community.”

Reference: “Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses” by Stephanie Mathieson, Joshua R. Zadro, Sujita W. Narayan, Andrew J. McLachlan, Jane C. Ballantyne, Fiona M. Blyth, Richard O. Day, Christopher G. Maher, Hanan McLachlan, Chung-Wei Christine Lin, Steven J. Kamper and Christina Abdel Shaheed, 25 February 2026, Drugs.
DOI: 10.1007/s40265-026-02284-3

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