Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses

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. REGISTRATION: ROSPERO CRD42018109733.