New York Mandatory Education for Prescribing Controlled Substances - 3 Contact Hours

Acute pain is defined as pain that has an abrupt onset and offers a warning of a disease process or a threat to the body (International Association for the Study of Pain [IASP], 2023). Management of acute pain may include opioids. While good pain control is important in patient care, opioids for acute pain increase the risk of long-term opioid use. Caution must be used because long-term opioid use often begins with treating acute, self-limiting afflictions. Ideally, opioids should be prescribed only when necessary, with the lowest effective dose, and for the shortest duration possible.

The Centers for Disease Control (CDC) suggests that opioids should only be used when necessary and at the lowest effective dose. Less than three days of opioid medication is appropriate for nontraumatic nonsurgical pain (Dowell et al., 2022). Immediate-release opioids are recommended for short-term use. Although, some instances of acute pain may require more than three days.

New York City has published guidelines for the use of opioids. They recommend that most patients require three or fewer days of therapy, be given short-acting medication, and should be evaluated for addiction or misuse. The guidelines also recommend avoiding administering benzodiazepines and opiates together and using extreme caution with stolen, lost, or destroyed prescriptions (NYC Health, n.d.).

When too many pills are prescribed, there are “leftover pills.” These “leftover pills” may be used for diversion or abuse. Nonetheless, it is often difficult to predict how much acute pain each patient has and how many pills to prescribe.

One study showed that continuous opioid use occurred after surgery between 5.9% and 6.5% of the time (Brummett et al., 2017). Factors that increase the risk of continued opioid use include a history of alcohol or drug abuse, lower socioeconomic status, multiple medical comorbidities, depression, prescriptions for benzodiazepines or antidepressants, and preoperative pain.

When prescribing opioids for acute pain, it is important to differentiate between opioid-naïve patients and opioid-experienced patients. Opioid naïve patients have not had opioids in the last 30 days.

The goal of pain management should be tolerable pain levels with good function. Here are some guidelines for how long medications should be given to those with acute pain (Pino & Wakeman, 2025).

• Mild pain syndrome should generally be treated with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) and nonpharmacological therapy.
• For individuals who suffer from moderate pain, such as after minimally invasive surgery, simple fractures, and soft tissue surgery, a three to five-day course of a short-acting opiate may be appropriate.
• For individuals who suffer from severe pain, such as after a major surgical procedure, total joint replacement, or compound fracture, higher doses of opioids may be used for about one week.
• One study examined the number of pills needed after procedures for 80% of patients. It showed that after laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, or an open inguinal hernia repair, patients required 15 pills of oxycodone at 5 milligrams (mg), whereas partial mastectomy patients required five pills (Hill et al., 2017).
• Predicting the number of medications patients will need after discharge from their procedure can be ascertained from the number of pills the patient took the day before discharge. One study showed that patients who received 1-3 pills on the day before they were discharged from the hospital took a mean of 7.6 pills after they were discharged from the hospital. Individuals who took four pills on the day before discharge took 21.2 pills after being released from the hospital (Hill et al., 2018).