Dear HIFA colleagues,
In our recent thematic discussion sponsored by NextGenU.org I learned that opioid drugs are largely ineffective for chronic pain conditions, despite their widespread use and consequential addiction.
I was interested to see this new paper that suggests opioid drugs have limited impact on acute pain.
CITATION: Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses
Systematic Review in Drugs journal
Published: 25 February 2026
Volume 86, pages 533–550 (2026)
https://link.springer.com/article/10.1007/s40265-026-02284-3
ABSTRACT
Background
Opioids are commonly prescribed for acute pain. However, there is no overarching synthesis on their efficacy.
Aim
We set out to conduct an overview review of the efficacy and harms of opioid analgesics for acute pain.
Methods
Electronic databases were searched until 4 March 2025 without restriction for systematic reviews of randomised trials comparing opioids to placebo/no active treatment for any acute, non-malignant pain condition published since 2010. Screening, extraction and quality assessment were conducted independently by two authors. The primary outcome was pain. Secondary outcomes were adverse events. Data timepoints were immediate (≤ 3 h after administration—primary timepoint), short (> 3 to ≤ 6 h), intermediate (> 6 to ≤ 48 h) and long term (> 48 h). Random effect meta-analyses were conducted. AMSTAR 2 described review quality. Grading of Recommendations Assessment, Development and Evaluation determined evidence certainty.
Results
We included 59 reviews. There was high certainty some opioids (morphine, oxycodone, tramadol, papaveretum) reduced acute abdominal pain at immediate term (mean difference [MD] − 18.4, 95% CI − 31.9 to − 5.0) compared with placebo. However, there were no harms data. At immediate term, there was moderate certainty opioids reduced pain including dental surgery (MD − 19.5, 95% CI − 25.0 to − 14.0), and myringotomy (MD − 15.0, 95% CI − 19.6 to − 10.4). However, harms data were only available for dental surgery, finding no increased risk of adverse events. Oral opioids provided only very small pain relief for acute musculoskeletal pain at intermediate term (MD − 8.9, 95% CI − 13.5 to − 4.3; moderate certainty) but increased the risk of adverse events (risk difference [RD] 0.1, 95% CI 0.0 to 0.2; moderate certainty).
Limitations
Some opioids are not consistently efficacious across timepoints.
Conclusions
Opioid analgesics are efficacious in reducing pain in some acute conditions.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org