The world鈥檚 largest review of听opioid pain relievers听prescribed for听acute pain found these medicines听provide only small, short-term relief for some acute conditions and are ineffective for听some听others.听
Led by researchers from the University of Sydney, the study set out to review the efficacy and harms of opioid pain relievers, such as codeine,听morphine, oxycodone, tramadol, compared with placebo听for acute pain.听The review includes 59 systematic reviews covering听more than听50 acute pain conditions in children and听adults, and maps听where opioids are effective and where evidence is lacking, providing the strongest and most comprehensive evidence to date.
The findings听were听published today in听, one of the most prestigious journals on medicines.
鈥淥pioids 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听for听the vast majority of听acute pain conditions, with pain relief typically lasting only a few hours,鈥 said听lead听author 听from the University of Sydney School of Public Health.
鈥淥verall,听oral听opioids听were听only slightly听better than placebo听for听acute听musculoskeletal pain, which they are often prescribed for,听in the听six听to 48 hours after starting treatment. Opioids also听increased the risk of side effects when used for acute musculoskeletal pain, some types of post-surgical pain听or听traumatic limb pain.
鈥淏y showing that the benefits are听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 鈥榞o-to鈥 option for acute pain."
高清福利片 challenges the widely held belief that opioids are the most effective 鈥榞o-to鈥 option for acute pain.
Associate Professor Christina Abdel Shaheed
School of Public Health
Key findings of opioid effectiveness for acute pain:
- Opioids provide only small,听time-limited听pain relief for some pain conditions like stomach pain, dental surgery, ear procedures, traumatic limb pain, pain following childbirth, caesarean pain and bunionectomy (bunion removal).
- Opioids听were no better than placebo听for some limb surgeries,听kidney stone pain, pain after removal of tonsils and听pain in newborns on assisted breathing devices.
- Opioids听were not consistently听beneficial over time听for heart-related pain, pain following hysterectomy听(removal of a woman鈥檚 uterus) and听topical use听(patches)听for听dermatological (skin) pain.听
- Opioids increased the risk of side effects听compared with placebo听when used for acute musculoskeletal pain,听traumatic limb听pain听补苍诲 pain after some types of surgery.听Side effects included听nausea and vomiting.
- Very short-term听use of opioids can reduce pain for some听acute听conditions,听however,听regular use听comes with a risk of harm听including dependence and tolerance. Serious opioid-related harms听can听include听misuse,听overdose,听hospitalisation听补苍诲听deaths.
- Inadequate reporting of side effects means the true risks of these medicines are听likely underestimated, urging better reporting of harms in clinical trials, and highlighting the need for safer, and more effective alternatives.
- Overall, the evidence does not support regular opioid use for acute听pain听补苍诲听some听studies evaluated single doses, which does not reflect real world use.
Concerns over opioid use and misuse
鈥淧ersistent use of opioid medicines can develop quickly following first time use (sometimes within days),听补苍诲听may arise from regular use for acute pain,鈥 said co-first author from the University听of Sydney鈥檚听听补苍诲 School of Pharmacy.听
鈥淚t is important that patients are informed about the potential harms from听opioids听when prescribed them, and that doctors prescribe these medicines judiciously (lowest effective dose for the smallest amount of time) for acute pain,鈥 she said.
Co-first author from the Institute for Musculoskeletal Health and School of Health Sciences听added:听鈥淭hese findings are important for听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.鈥
Research
Mathieson, Stephanie, Abdel Shaheed, Christina,听et al., 鈥楨fficacy and harms of opioid analgesics for acute pain: overview of systematic reviews and meta-analyses鈥櫶(Drugs, 2026)
DOI: 10.1007/s40265-026-02284-3
Declaration
Associate Professor Christina Abdel Shaheed holds grants from the National Health and Medical Research Council and Medical Research Future Fund. Associate Professor Joshua Zadro holds a grant from the Medical Research Future Fund. Dr Stephanie Mathieson has no conflict to declare.
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