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Non-Opioid Management of Acute Pain
Acute Pain Management Is Not All or Nothing: Expanding the Non-Opioid Toolbox

Released: August 10, 2026

Michael Sprintz
Michael Sprintz, DO, DFASAM
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Key Takeaways
  • Acute pain management should be individualized. Analgesic needs vary by the patient, procedure, and clinical context, reinforcing the importance of patient-centered treatment decisions rather than one-size-fits-all prescribing.
  • Undertreated acute pain can delay recovery, impair function, increase patient distress, and may result in seeking external or even illicit sources for pain relief, which increases risk of patient harm. Timely, effective analgesia is a key factor for optimizing patient outcomes.
  • Novel non-opioid analgesics expand the multimodal options available for acute pain management and support opioid-sparing strategies, with agent selection guided by the procedure, the patient's comorbidities, and the available evidence.

For years, the conversation about acute pain has swung between 2 extremes. Opioids were once treated as the default answer for nearly every patient with acute moderate to severe pain. More recently, the opioid epidemic and concern about opioid-related harms have pushed the pendulum to the opposite extreme, leaving healthcare professionals (HCPs) fearful of legal repercussions and creating the impression that prescribing any opioid represents poor care. Neither extreme serves patients well.

Opioids are not inherently “good” or “bad.” They are medications with clinically meaningful benefits and well-established risks. For some patients, an opioid may remain an appropriate component of treatment. For others, opioid exposure can be reduced or avoided without compromising patient outcomes. Rarely in medicine are things “black and white.” There is a lot of gray, and a guiding principle of clinical decision-making is determining whether the benefits outweigh the risks in this patient with this clinical scenario at this time. Although the decision to prescribe an opioid or not for a patient takes into account population-based data and statistics, ultimately, it comes down to THIS PATIENT. Never prescribing opioids can be as harmful as always prescribing opioids, and this type of thinking appears on the surface as an abdication of our responsibility to provide patient-centric care.

Undertreated acute pain is its own harm. Inadequate analgesia delays mobilization and recovery, disrupts sleep, prolongs the postoperative stay, and contributes to unplanned return visits after discharge. It also drives some patients toward self-treatment, whether through alcohol, pain medication obtained from a friend or family member, or medication acquired illicitly, each of which introduces risk that could have been prevented with adequate analgesia in the first place. At the same time, opioid-related adverse effects, including sedation, respiratory depression, gastrointestinal distress, and high addiction potential, can complicate recovery and delay postoperative discharge. In one large study of opioid-naive adults undergoing surgery, approximately 6% exhibited persistent opioid use (90-180 days post operation), with behavioral and pain-related factors contributing more strongly to continued use than the magnitude of the procedure itself. This further highlights that the way to provide better acute pain care is by tailoring our clinical decisions for each patient to maximize benefit and minimize risk.

Pain Is More Than a Tissue Injury
A standardized prescription protocol may be administratively convenient, but pain is not standardized. Pain is an experience produced by interactions among tissue injury, peripheral and central neural signaling, prior experiences, expectations, psychological state, and the patient’s social environment. Two people undergoing the same procedure may require different approaches because they arrive with different physiologic vulnerabilities and different histories.

A patient who previously experienced severe undertreated pain may approach another procedure with substantial anxiety. Another patient may have high levels of catastrophizing, trauma-related symptoms, or fear of losing control. These factors can amplify the pain experience and influence the patient’s response to treatment.

This is why counseling, patient education, and good communication are part of perioperative care delivery. Before a procedure, HCPs should discuss the expected trajectory of pain, establish realistic expectations and functional goals, explain the treatment plan, and tell patients what to do if the initial regimen is insufficient. “You will have no pain” is usually not a realistic promise. “Our goal is to keep your pain controlled enough that you can sleep, move safely, and participate in your recovery” is more useful. The patient should also know that the plan can be adjusted, and communication is essential on both sides. A rigid regimen based only on what usually works for a population is not the same as patient-centered care.

Move Beyond the Opioid–Non-Opioid Divide
Another limitation of the current conversation is that “opioids” and “non-opioids” are often presented as an “either/or” situation. In practice, a multimodal acute pain plan combines interventions with complementary mechanisms while limiting the dose-dependent disadvantages of any one option. A plan that uses non-opioids while having an opioid reserved for breakthrough pain when needed, rather than functioning automatically as the foundation of the regimen, fits well into this multimodal approach.

Of importance, planning should begin before the pain becomes severe; preventing pain is easier than chasing it. For acute postprocedural pain, this may mean coordinating preoperative, intraoperative, and postoperative interventions rather than waiting until a patient is in severe pain at home where the HCP may be more constrained in options.

A New Peripheral Target Enters Clinical Practice
In January 2025, the FDA approved suzetrigine, a first-in-class sodium-channel blocker, for moderate to severe acute pain in adults. Suzetrigine is the first FDA-approved NaV1.8 inhibitor and provides analgesia through a targeted peripheral mechanism without directly activating opioid receptors in the central nervous system.

In 2 phase III trials involving adults with moderate to severe pain after abdominoplasty or bunionectomy, suzetrigine significantly reduced pain compared with placebo over 48 hours with similar pain reduction to hydrocodone/acetaminophen. As HCPs continue to work toward providing patients with individualized care for pain management, having a drug with similar efficacy to hydrocodone but no direct central nervous system impact expands the range of patients for whom an opioid-sparing or opioid-free strategy may be feasible. However, a new non-opioid analgesic does not eliminate the need for clinical judgment, so it is important to consider which patients are good potential candidates.

Potential candidates may include patients who:

  • Have obstructive sleep apnea, reduced respiratory reserve, or other factors that increase concern about opioid-related respiratory effects
  • Have experienced previous adverse effects with opioids
  • Have a personal or family history suggesting increased vulnerability to substance use disorder
  • Prefer to avoid opioids after a shared decision-making discussion
  • Cannot use nonsteroidal anti-inflammatory drugs (NSAIDs) because of renal, gastrointestinal, cardiovascular, or other risks
  • Need moderate to severe acute pain control within an individualized multimodal regimen

This is not an exhaustive eligibility checklist. It is a reminder to ask whether the familiar postoperative prescription is truly the best option for the patient in front of us.

“Non-Opioid” Does Not Mean “Risk Free”
Although non-opioid analgesics can reduce or avoid many of the risks associated with opioid exposure, no medication is risk-free. Traditional options have their own important limitations. Acetaminophen requires attention to total daily exposure because of the potential for hepatic toxicity, while NSAIDs may be inappropriate for patients with gastrointestinal, renal, cardiovascular, or other relevant risk factors. Treatment selection therefore should not be framed simply as “opioid versus non-opioid,” but as a patient-centered decision that considers the expected benefits and risks of each available option in the context of the individual patient. Even when the most appropriate therapy is selected, some degree of risk remains, an inherent part of clinical decision-making.

Suzetrigine is no exception. Its use requires attention to clinically important drug interactions. Concomitant use with strong CYP3A inhibitors is contraindicated; the dose should be reduced when it is used with moderate CYP3A inhibitors, and concomitant use with strong or moderate CYP3A inducers should be avoided. These considerations reinforce the same principle. HCPs need to understand the specific benefit–risk profile of the medication they prescribe and apply it to the circumstances of the individual patient. Suzetrigine represents an important addition to the acute pain treatment landscape, expanding clinicians’ ability to provide effective analgesia while avoiding some of the most consequential risks associated with opioids and limitations of traditional non-opioid therapies. As additional novel non-opioid options emerge, clinicians will have an increasingly versatile therapeutic toolkit to individualize acute pain management according to each patient’s needs, comorbidities, and risk profile.

How Will This Change My Practice on Monday?
The most useful medical education is education that changes how we practice during the next clinical encounter and beyond. Before finalizing an acute pain plan, consider 5 questions:

  1. What level and duration of pain should be reasonably expected? Consider the procedure or injury, anticipated inflammatory and neuropathic components, and the patient’s prior experiences.
  2. What patient-specific risks affect the treatment selection? Review respiratory disease, sleep apnea, renal or hepatic function, gastrointestinal and cardiovascular risk, current medications, previous adverse effects, pregnancy potential, and substance use history.
  3. What can be addressed before pain escalates? Consider patient education, realistic expectation setting, regional or local techniques, and perioperative multimodal treatment.
  4. Can a novel non-opioid therapy reduce or eliminate the need for an opioid? Evaluate the indication, evidence, contraindications, interactions, access, and patient preferences. Reduction of dose or duration of opioid use can make a difference.
  5. What is the rescue and follow-up plan? Patients need to know what to take, when to take it, when to stop, what adverse effects to watch for, and whom to contact if pain remains uncontrolled.

The arrival of targeted non-opioid analgesics creates a great opportunity to move beyond habitual prescribing and expand our options to effectively manage pain with less risk. It does not require abandoning opioids when they are clinically appropriate. It requires replacing reflexive, one-size-fits-all prescribing with deliberate, patient-centered planning. The next phase of acute pain management will not be defined by choosing one side of an opioid debate. It will be defined by whether HCPs can match an expanding range of therapies to the needs, vulnerabilities, and goals of each patient.

Your Thoughts
What changes in your current workflow would make it easier to individualize acute pain treatment and reduce unnecessary opioid exposure?

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