The largest review of its kind suggests opioids may offer far less relief for acute pain than commonly believed.
The largest analysis ever conducted on opioid pain medications used for acute pain has found that these drugs offer only modest, short-lived relief for certain conditions and do not work at all for others.
Researchers at the University of Sydney led the investigation, which examined both the benefits and risks of opioid pain relievers (e.g., codeine, morphine, oxycodone, tramadol) compared with a placebo in cases of acute pain.
The project brought together 59 systematic reviews spanning more than 50 different acute pain conditions in both children and adults. By compiling and evaluating this wide range of data, the team identified where opioids show measurable benefit and where evidence is weak or absent. According to the authors, this represents the most comprehensive and up-to-date assessment of when opioids are, and are not, effective for short-term pain.
The results were published in Drugs, a leading medical journal focused on pharmaceuticals.
“Opioids 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 for the vast majority of acute pain conditions, with pain relief typically lasting only a few hours,” said lead author Associate Professor Christina Abdel Shaheed, from the School of Public Health at the University of Sydney.
“Overall, oral opioids were only slightly better than placebo for acute musculoskeletal pain, which they are often prescribed for, in the six to 48 hours after starting treatment. Opioids also increased the risk of side effects when used for acute musculoskeletal pain, some types of post-surgical pain, or traumatic limb pain.
“By showing that the benefits are 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 ‘go-to’ option for acute pain.”
Where Opioids Help — and Where They Don’t
Key findings of the systematic overview and meta-analysis:
- Opioids were associated with only modest, short-term pain relief for certain conditions, including stomach pain, dental surgery, ear procedures, traumatic limb pain, pain after childbirth, cesarean pain, and bunionectomy (bunion removal).
- For other conditions, opioids performed no better than placebo. These included some limb surgeries, kidney stone pain, pain after the removal of tonsils, and pain in newborns who require assisted breathing.
- Benefits were not consistent over time for heart-related pain, pain following hysterectomy (removal of a woman’s uterus), or the topical use of opioids (patches) for dermatological (skin) pain.
- Compared with placebo, opioids increased the likelihood of side effects when used for acute musculoskeletal pain, traumatic limb pain, and certain types of post-surgical pain. Reported side effects included nausea and vomiting.
- Although very short-term opioid use may reduce pain in some acute situations, ongoing use carries risks, including tolerance and dependence. More serious harms linked to opioids include misuse, overdose, hospitalization, and death.
- Because side effects were not consistently reported in many trials, the actual risks of these medications may be underestimated. The authors call for improved reporting of harms in clinical research and emphasize the need for safer and more effective alternatives.
- Overall, the findings do not support regular opioid use for acute pain. In addition, some studies examined only single doses, which may not reflect real-world prescribing and use.
Concerns over opioid use and misuse
“Persistent use of opioid medicines can develop quickly following first-time use (sometimes within days), and may arise from regular use for acute pain,” said co-first author Dr Stephanie Mathieson from the University of Sydney’s Institute for Musculoskeletal Health and School of Pharmacy.
“It is important that patients are informed about the potential harms from opioids when prescribed them, and that doctors prescribe these medicines judiciously (lowest effective dose for the smallest amount of time) for acute pain,” she said.
Co-first author Associate Professor Joshua Zadro from the University’s Institute for Musculoskeletal Health and School of Health Sciences added: “These findings are important for 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.”
Reference: “Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses” by Stephanie Mathieson, Joshua R. Zadro, Sujita W. Narayan, Andrew J. McLachlan, Jane C. Ballantyne, Fiona M. Blyth, Richard O. Day, Christopher G. Maher, Hanan McLachlan, Chung-Wei Christine Lin, Steven J. Kamper and Christina Abdel Shaheed, 25 February 2026, Drugs.
DOI: 10.1007/s40265-026-02284-3
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45 Comments
Despite her conclusions, my knee and hip replacement experiences showed me that codeine was effective at greatly reducing the associated pain, but the risks of addiction were high!!
My experience was the same. My prescribed Vicodin greatly reduced my severe pain after internal surgery and at the 3-week point when I wanted to refill the prescription and received a message that I needed to speak with my doctor first I realized at that point I probably should be not dependent on it. I decided just not to renew the prescription and sure enough my whole world was crashing down with depression like I had never felt before because of the addiction I had formed in just 3 weeks time! That was quite the enlightening experience!
I think addiction depends on how your brain is wired . I have “failed back syndrome” and have had many surgeries. I always managed my pain meds carefully. And yes, I did need them, and yes, they did help get me through some very bad times .
Many points in this article are so irrelevant to discovery that they feel dishonest.
The idea of there being multiple pain networks and that different drugs work on different networks is solid and important.
Length or amount of pain relief isn’t dismissabable. Even drug induced distraction can be critical.
Addiction is an important use consideration. Its completely irrelevant to how well a drug works.
Injury and aggravation from increased activity is a significant problem with studies like this. Immobilizing pain that gets reduced always leads to increased physical activity. This is usually a positive but usually has one or more downsides that chart as failures and make the overall impact look bad.
Opiates work for a few hours. So what? If you manage trailing blood levels to be as flat as possible you significantly reduce addiction and increased tolerance in long term use. The quest for longer relief leads to higher doses less often which cause cravings and withdrawals every 8 hours. Half the long term dose every 4 hours flattens the blood levels enough to significantly reduce if not eliminate both.
Why is tramadol classified as an opiate? There’s no opium in it.
What a joke! It’s like saying water isn’t effective for quenching thirst because you just get thirsty again or food isn’t effective against hunger because you get hungry again hours after eating and they’re called pain relief medication not magic erase pain for ever medication so just like thirst/hunger requires multiple daily doses of food/water wouldn’t chronic pain require the same of pain medication that only provides relief in hours at a time. So if food,water & pain relief medication are inefective what’s the alternative they sure didn’t say or would that make the study irrelevant nonsense lol!!!
What a joke! It’s like saying water isn’t effective for quenching thirst because you just get thirsty again or food isn’t effective against hunger because you get hungry again hours after eating and they’re called pain relief medication not magic erase pain for ever medication so just like thirst/hunger requires multiple daily doses of food/water wouldn’t chronic pain require the same of pain medication lol
Something related to addiction possibilities. Without tramadol 25mg twice a day I would have given up living. I have hard horrible nerve pain for 30 years. Most doctors said it was in my head. Moved and my new Dr did tests. The nerve conduction tests proved there was something wrong. I tried everything recommended but nothing helped. Gabapentin made me too foggy to complain about the never ending pain but it didnt help it. Finally as a last hope he let me try tramadol. It doesnt stop the pain but dulls it enough so I can stop whimpering and crying frequently. I have never upped my dose even though my doctor said I can if needed but I am trying to keep the dose as low as I can.
I have osteoporosis and arthritis in all of my joints. My pain management dr cut me off in June of 2025.i amm in so much pain I can’t clean my house or mow my lawn. Iam 70 live alone and have no family.what am I to do.signed much pain no relief.
And this is why I have six surgeries I need…but refuse to have. I will not allow the healthcare industry to torture me with inadequate post-op pain management. It is also why I currently get my pain management care from “Dr. Clyde on the corner”.
So, yeah….Kolodney and his misguided band of sycophantic sadists can congratulate themselves on directly contributing to the very problem they claim to want to solve.
Her entire hypothesis was tested by applying ONE DOSE???
Her findings are meaningless. Apparently she hasn’t heard of sample size increasing the accuracy of one’s study.
This is absolutely worthless for any of the instances she cites.
I, personally have had nearly 20 orthopoedic surgeries, including back fusion and hip replacement. I’m living proof opioids used correctly vastly improve patients quality of life, just ask the AMA!!!
Theslead(ie; lie)ady been tried in the past and proven not to work. This a “scare tactic” The idea is to hopefully deter ppl from takingthedrug by misleading (lie)by only teaching ppl by focusing on the” cons” and leave out the pros of the drug giving the impression that you taught them a factual unbiased definition of what opiates are. In the past their strategy was to say & dowhat ever takes as long as it deters ppl from taking it including saying things that are not true. Like “Smoking one marijuana cigarette will make you will literally go” straight kacketinsane” IItbwas a movie called ” Reefer Madness ” A lot of ppl believe d every word. You can say whatever it takes including li e as long as they don’t t try it! *Sound familiar?
Hang on!
Before you trash pain reducing opioids, my question for you is: Compared to what?
Name one damn effective pain reduction drug that isn’t dope based. You can’t. So shut up until you have a real alternative .
Are these people insane? Anyone who has had a root canal knows opioids are effective for pain. Every medication only lasts a few hours, typically 4-6 hours unless it is a timed release formulation. If initial dosage is adequate pain control is good. You can’t give people trivial amounts and expect good results. Are aspirin and Motrin thought to be ineffective because they only last a few hours?These people are repeating fallacies we disproved 20 years ago. If initial dosage is adequate you can go for decades without needing a dosage increase.
What a BS article. Of course, opiods are only of short duration. This is why they need to be available PRN – as needed – every 4 – 6 hours.
AND THEY WORK. NOTHING ELSE DOES.
Agree..
My mother was on hydrocodone for her back pain a good 20 years- same dose, same doctor, and only the 1 RX every month. She would have never been able to get relief from anything else because she was allergic to aspirin, and any over the counter pain meds, besides Tylenol would terribly upset her stomach.
You are correct… Had many dental procedures and also had an abscess where I just wanted to die. Even with opiate pain meds it sometimes just made pain barely tolerable.
I also have a huge tolerance for opiates which means I need more than usual person to work🙄…try explaining THAT unless the dr knows you…morphine does nothing for me AT all .have to have dilaudid..i have had 4 colitis attacks. That is how I learned That.
It went from lax if not illicit prescribing to having some idiots decide Guidelines for rx dosage limits…that make nonsense. Individualized care is needed. One size does not fit all..ever
I agree.
I agree. There are many of us in needless pain due to this belief.
Before the “fight on opiates” I was getting good pain relief for my 3 failed back surgeries. Now, I’m supposed to get adequate relief from dangerous seizure medications that cause dementia.
More DEA funded hocus pocus. The fact that opiates don’t permanently stop the pain does not make them ineffective. That’s the way they work. If you have ever had a surgery that few hours with no pain allows you to move,cough and deep breath and actually get better. I question if this had any real people in real pain such as post op, fractures, sepsis etc. This supposed “new”* information is based on flawed so called research. The efficacy of opiates in acute pain has been proven again and again over the last hundred years. This study means nothing. Adds nothing to current knowledge. The so called results beg the question who payed for this study. Waste of time.
Agree..
More DEA funded hocus pocus. The fact that opiates don’t permanently stop the pain does not make them ineffective. That’s the way they work. If you have ever had a surgery that few hours with no pain allows you to move,cough and deep breath and actually get better. I question if this had any real people in real pain such as post op, fractures, sepsis etc. This supposed “new”* information is based on flawed so called research. The efficacy of opiates in acute pain has been proven again and again over the last hundred years. This study means nothing. Adds nothing to current knowledge. The so called results beg the question who payed for this study. Waste of time.
This study was the most glaring condition of “Bulls***”. If you are talking about opioid naive patients, then maybe. But If I didn’t have both fentanyl and oxymoron, I would be bed bound and unable to have any kind of life whatsoever. The meds curb my pain and allow me to function and its been like this for 30 years. Where were people like me in the study? Because I can tell a placebo within about 15 minutes. I broke my neck, had a fusion at c5/6 never healed right. Then developed CIDP BY 50 AND HAD A FULL HIP REPLACEMENT AT 65. These studies are rigged because myself and many others know better.
Agreed. The slightest opioid epidemic and all of a sudden we ignore 1000s of years of knowledge and experience!
This is the. BIGGEST LIE , these doctors and professors who are not chronic pain patients are killing patients who need pain medicine by refusing it to people. I have chronic pain since experimental Herrington Rod surgery 1960 fused top to bottom have been on pain med for over 50 yrs never abused or have I any other medical problem from taking them. By denying them people will seek relief on the streets and you are reason. I hope these doctors need pain relief someday and get denied. These doctors are being paid not to prescribe. I have lived in chronic pain everyday 20 yrs due to DEA,FDA CUT BACK ON MEDICINE IN USA. Dogs get better care then humans in USA.
I think this study was for the use of opioids for acute pain, not chronic pain. We all know the risk of addiction. There are some people who will lie (that they didn’t know) and others who don’t care. The withdrawal symptoms can be the cause of chronic pain. Therein lies the dependency. That said, opioids are one of name greatest inventions IMHO.
They should stop wasting money on studies that we know the results to. If AI have pain warranting pain medication that Tylenol or Advil doesn’t help, then I’m reaching for the thing that has helped for millennia, opiates. They can bulls*** as much as they’d like. We all know what works and what doesn’t.
They also fail to mention that placebo stops working when you know it’s a placebo whereas opiates work regardless, even if it’s for just a few hours. The pathetic doctors are wasting tax payer dollars to tell everyone that the sky is not falling. Give me a break!
I have had 10 orthopedic surgeries since 2003. I could not have gotten through any of them without pain meds. Especially the last thoracic surgery. Unless you have experienced severe pain and only given a placebo, you don’t know what your talking about.
Wow, you people must be the lucky ones, that never get hurt or have anything happen to you!
I want to dig in your mouth and cut your gums up and tell you to go and meditate.
I want to see you have kidney stones and slap your back and say it’s all good for for a walk.
I want to see you have a. Spine injury and say stretch it out and drink some tea.
You are all crazy writing this stuff. Why have something that helps and now not help…
Tell the doctors that give 100 pills all the time to stop and work with the patient! How about that! An oath was taken to help people and no one is the same. Are you judging me and my pain. That’s called pain phobia now and I don’t appreciate it!
I think addiction depends on how your brain is wired . I have “failed back syndrome” and have had many surgeries. I always managed my pain meds carefully. And yes, I did need them, and yes, they did help get me through some very bad times .
I have failed back syndrome too and a fused spine from L3-S1 that followed to correct what the failed back syndrome caused. Was given so many different pain meds throughout the years to help with the pain and the only thing that it did was made me dependent on them. Years later I took myself off of them, even had kidney stones and oral surgeries without anything for the pain in fear of going backwards. Pain meds can make your pain feel worse believe it or not. After coming off of them and letting my body normalize, it realized that it wasn’t in as much pain as it had thought. I actually hurt less without them than I ever did with them. I never believed my doctors or the studies when they told me about this, including the pain/depression cycle but until you’ve lived it? Well..
Now I’m looking at more fusing above my current fusion sooner rather than later. I’ll hold off as long as I can when it comes to any meds.
Its unfortunate, but they would literally have us die from pain then dole out “too much” pain relief. It has a lot to do with lawmakers who, you can bet, make sure to get ALL they need. Or their family members. They act like they’re doing out tablets of gold. Its just absurd. Next they’ll tell us a drink of water works better.
It was supposed to say “doling out”, but as usual, AI “knows” better….
Oh, and i couldn’t post a simple reply until the OP is approved. Somebody has a hang up about being in control, I’d say….
Well folks if you’re in massive pain, constant discomfort, and are given to the fact that you’re addicted to pain medication and are for life just to function, my recommendation is methadone. Not the red liquid. The beige biscuits. Many doctors frown on these, but once stabilization has occurred it can be regulated. Methadone is the cure. It’s addicting, but a proper , and regulated set-up. Finding it within the medical community is a matter of going through a community services set-up, generally in larger populated cities and towns. I’ve dealt with lower back surgeries since my youth in the Eighties. Found methadone in 99. I can do pretty much anything I feel. Good luck.
How do you get a doctor to let you give this a try? I’ve been on opiods for more then 10 years im taking 10mgs Oxycodone 4x a day with Gabapentin 800mg 4x a day and I can’t hardly get out of bed without major pain just walking to the mailbox much less back. I can’t seem to get through to the last 3 pain doctors I have had out of the 4 I have been to over the years. I have always been active and now all I do out of 300 days a year and thats probably a low number is lay in bed and it is truly killing me.
Well folks if you’re in massive pain, constant discomfort, and are given to the fact that you’re addicted to pain medication and are for life just to function, my recommendation is methadone. Not the red liquid. The beige biscuits. Many doctors frown on these, but once stabilization has occurred it can be regulated. Methadone is the cure. It’s addicting, but a proper , and regulated set-up. Finding it within the medical community is a matter of going through a community services set-up, generally in larger populated cities and towns. I’ve dealt with lower back surgeries since my youth in the Eighties. Found methadone in 99. I can do pretty much anything I feel. Good luck.
These alleged “studies” appear to be carefully crafted to justify a certain political point of view. The bizarre conclusions they have reached are unbelievable. Does anyone remember a study a few years ago that claimed “morphine no more effective than aspirin” ? When you looked at the methodology more closely you discovered they had given a bunch of guys with arthritis at a VA hospital either 5 milligrams of morphine or 325 milligrams of aspirin and asked them which was better. They replied neither helped much with their pain. Slightly more favored the aspirin. The headline generated was “study proves morphine no more effective than aspirin”
After a botched kidney surgery 13 years ago. My life saver is 7.5mg Of Norco 3x a day. I was with Kaiser for a few years and those a-holes would not give me my Norco no matter what. So when I had chance to move to Medicare I got a great Dr. Who sent me to a pain clinic no preconceived notion that opioids are the devil just Dr. Who understand chronic pain.
I’ve never had any relief from opioids. When I have dental work, they always prescribe narcos. I never fill it. It never made much sense. Why take opiates after getting the problem fixed. I usually have zero pain after dental work. Likely due to the Tylenol and IBU I take combined.
For surgeries I had, percocet made me sick and nauseous. I just took Tylenol and ibu combined and it was like magic.
I worked in addiction, i’ll pass on the narcs.
I am glad you can pass on opioids, Clinton. It shows that you are given the option. The problem is when patients are denied prescription narcotic pain medicine. Not everyone will become addicted but now fear of addiction is causing many to suffer unnecessarily. Addiction can’t be stopped by refusing medicine to patients, in the same way that diabetes can’t be cured by stopping insulin.
Lol my favorite part was how they compared pain medicine to placebos!! Pain meds are slightly better than placebos??? Really?? Do the people they were testing even know what placebos are?? It’s a sugar pill!! Like you said it’s for pain relief not a cure and let me tell you if I can only hurt 12 hours out of a 24 hour day…Im blessed. Pain does more to your mental state. People kill themselves because they hurt so much. Let them keep doing this. More and more people are going to turn to the streets because doctors are to scared to write medicine that works for the patients.
More then half of these comments say they disagree…jsin…I think this is conspiracy. They started acting funny when the Taliban outlawed poppy harvesting in 2017
I love to know which big pharma paid for this study, and which one of thier meds “WORK BETTER.”