Opioid Use and Pain Resolution in Opioid-Naive Adults With Acute Pain
Key Takeaways
- Pain commonly lasted beyond opioid exposure, and the longest recovery times were seen after surgery and with low back pain.
- Opioid use typically ended after a median of 7 days, although 10.0% of patients were estimated to use opioids for at least 90 days.
- Early treatment often combined opioids with acetaminophen or ibuprofen and nonpharmaceutical measures, while leftover medication and opioid difficulties were also commonly reported.
Investigators enrolled 1708 patients from 5 US health systems and community dental practices between September 2020 and March 2023 and followed them digitally for 180 days. Eligible participants were opioid-naive adults aged 18 years or older, plus adolescents aged 15 to 17 years undergoing impacted molar extraction at one site. Pain resolution was defined as the first of 3 consecutive completed surveys reporting no pain, and 1502 patients reported pain severity at least once. The median age was 38 years, and 615 patients, or 36.0%, reported race or ethnicity underrepresented in acute pain studies. Recruitment spanned emergency departments, primary or urgent care, dental settings, inpatient settings, and postsurgical care, creating a broad mix of acute pain sources.
Source-specific recovery was longest for postsurgical pain at 74 days, with an IQR from 30 days to not reached. Low back pain also showed prolonged resolution at 69 days, with an IQR from 18 days to not reached. Among 1482 patients who completed at least 1 survey during the first 15 days, 77.8% used opioids at least once and 86.8% used acetaminophen or ibuprofen at least once, while nonpharmaceutical treatment was also common. Opioid use peaked on day 2 and declined by day 14, and the median daily dose among patients with dose data was 10 MME. Overall, the early treatment pattern was largely multimodal.
Among 1189 patients who reported any opioid use, the median time to discontinuation was 7 days, with an IQR of 2 to 31 days. An estimated 10.0% used opioids for at least 90 days, with a 95% CI of 7.7% to 12.7%. Adjusted pain relief in the original investigation averaged 55.1% on nonopioid days and 60.6% on opioid days, while about one-third of severe pain days occurred without opioid use. Leftover opioids were also common, with 657 of 982 respondents, or 66.9%, reporting leftover medication. Leftover medication remained common despite generally brief opioid use.
On the first monthly survey, 519 patients answered at least 1 scorable PODS question at a mean response day of 32.4 days. Among those respondents, 22.2% reported any opioid difficulties, most often sleepiness when needing to be alert and feeling sluggish or sedated. Treatment use was self-reported, the analyses were descriptive rather than causal, and pain reports could reflect symptoms beyond the index acute episode.
Overall, opioid exposure was generally low dose and short duration, but prolonged use, modest pain relief, substantial leftover medication, and pain that persisted beyond opioid use were also observed.