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Dr. Lynch in the News

Navigating Acute Pain Management During the US Opioid Epidemic – An Interview With Experts

clinicalpainadvisor.com
Rita Aghjayan, MD
January 28, 2026

Acute pain management is a persistent challenge in the health care system with variability in patient demographics, clinical presentation, health care settings, and treatment availability. The growing prevalence of pain in the US is multifactorial due to surgical procedures, an aging population, and the rise in metabolic disorder diagnoses.1 With the increasing population of individuals with acute and chronic pain, streamlined symptom management is essential. Treatment options, such as opioids and nonopioids, have been available to patients with pain for many years; however, the opioid crisis, declared as a public health emergency in the US in 2017, created a paradigm shift, with conversations around pain management becoming more polarized.

James C. Hackworth, PhD, and colleagues discuss navigating acute pain management during the opioid crisis in a publication in Frontiers in Pain Research. The team explored causes of treatment gaps and the clinical implications that undertreatment has on acute pain.

Inadequate treatment of acute pain may lead to the development of chronic pain, which becomes more challenging for patients and providers to manage. Additionally, certain populations with more frequent episodes of acute pain might experience greater barriers during management. For example, the 2022 prescribing guidelines by the Centers for Disease Control and Prevention (CDC) titled, CDC Clinical Practice Guideline for Prescribing Opioids for Pain, include recommendations for treating pain and prescribing opioids in the outpatient setting for adults aged 18 and older, yet there are lack of recommendations for certain patient groups such as those with sickle cell disease, cancer, or those receiving palliative or end-of-life care.3 Along with the hesitation that some patients and providers feel around opioid-based treatments, the risk of undertreating acute pain increases.1 Variation in the longevity of pain, such as in acute, subacute, and chronic settings, as well as variability in the type of pain, as with neuropathic, inflammatory, traumatic, or postprocedural pain, lead to different approaches to management.

Some studies suggest that the increasing prevalence in obesity might also have direct and indirect associations with pain. Though the causal pathways between obesity and chronic pain are still not well understood, people with obesity may have up to 45% greater risk for chronic pain compared with people with weight in the normal range.4 Researchers suggest that obesity leads to insulin resistance, which can accelerate the progression of peripheral neuropathy.5 Individuals with obesity are also at risk of developing obstructive sleep apnea (OSA), which may inform health care professionals when treating acute pain. Patients with OSA receiving treatment with opioids may be at an increased risk for opioid-induced central sleep apnea and respiratory distress, which might lead clinicians to reduce treatment with opioids, and therefore, undertreat acute pain.6

“Despite their efficacy, opioids are associated with several important [severe adverse events], notably physical dependence, euphoria, risk of overdose, and respiratory depression, which together can lead to significant negative outcomes,” Hackworth and colleagues noted in their study. Major negative outcomes include the risks for dependence, misuse, progression to use disorders, overdose, and diversion and secondary harms. Some studies suggest that opioid dependence may develop in 11% to 13% of patients who are initially prescribed opioids and that dependence can occur in as briefly as 5 days of use.7 One study suggests that postoperative patients who received opioid prescriptions within 7 days after surgery were 44% more likely to be long-term opioid users within a year.8 Reducing or discontinuing therapy in these patient populations is often challenging with tapering of medications often leading to more emergency department (ED) visits and hospitalizations.

Some patients receiving opioids may experience euphoria, which is one of the most common reasons for its misuse. The sensation of euphoria is often a driving factor for the continuation of opioids past their medical need.9 Progression to use-disorder occurs following continuous misuse along with acute pain and opioid dependence. The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), published by the American Psychiatric Association (APA), describes opioid use disorder to include “signs and symptoms that reflect compulsive, prolonged self-administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition.”10 Prolonged use of opioids may not only lead to higher risk for overdose but may lead to abuse of more potent forms of opioids, as well as other substance use disorders.11

Polypharmacy is important when considering opioid-led treatments options. Opioids are concomitantly prescribed with other drugs, such as benzodiazepines, gabapentin or pregabalin, first-generation antihistamines, and tranquilizers, which all may synergistically cause respiratory depression. The risk for opioid-related adverse events increases with polysubstance use such as in the nonmedical use of other o-prescribed medications, alcohol, cocaine, and illicit substances.12

In efforts to prevent substance use and opioid dependence, providers and patients might refrain from discussing opioids as pain management options, potentially leading to unwanted treatment gaps. In addition to patient and provider uncertainty, factors such as state-level policies on access to opioids and the disregard for long-term consequences of ineffective acute pain management are some factors contributing to treatment gaps. “Many physicians have historically opted to treat pain with opioids; however, the substantial healthcare and societal costs associated with opioid use disorder and overdoses indicate that it may be time to adopt alternative, nonopioid approaches to pain management,” Hackett and team wrote.

Q&A With Experts

In an interview, Allan L. Cruz, MD, a medical oncologist in the Department of Medical Oncology at Jersey City Medical Center, in Jersey City, NJ and Joshua J. Lynch, DO, FAAEM, FACEP, professor of emergency medicine and addiction medicine at University at Buffalo, The State University of New York, in Buffalo, NY, describe some of the challenges that clinicians and patients may face while navigating pain management during the opioid crisis.

What are some of the most significant challenges clinicians might face when balancing effective acute pain relief and minimizing opioid use?

Allan L. Cruz, MD: There is not enough time in a 15-minute office visit to take care of acute pain. In patients with cancer undergoing chemotherapy and experiencing acute pain, some regimens are nephrotoxic, and therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) are not compatible for acute pain and Tylenol is usually insufficient in controlling pain [in these patient groups].

How do you educate patients about alternative pain management options?

Joshua J. Lynch, DO: We try to talk with patients about their options. Working in the emergency department (ED), the timing is variable with how much time we can spend with each patient. We talk about the addictive potential and the fairly low threshold it takes for [drug] dependence. Patients are also not always aware of what NSAID/acetaminophen combinations, nerve blocks, pain management, or interventional radiology can do.

What barriers exist to using nonopioid therapies for acute pain in clinical settings?

Dr Cruz: Our patient population is underinsured. It is hard to get complimentary nonpharmacologic therapy like massage, acupuncture, or other related therapies. If covered by insurance, we usually recommend [these treatments].

What resources or support are needed to improve acute pain management in the current opioid climate?

Dr Lynch: More education and public awareness is needed around the adverse effects of opioids, coupled with [evidence about] the efficacy of nonopioid measures. Public services to educate patients are very important to ensure that it is not all happening at the doctor’s office.

What should providers and patients know about the burden of acute pain and opioid use?

Dr Cruz: Acute pain and opioid use are [difficult-to-navigate] challenges, especially for patients with cancer. Sometimes, it is difficult to wean off these patients who do not need opioids after achieving complete response from cancer therapy.

Dr Lynch: People should be aware and not be afraid to speak up about their hesitancy about medications. Asking about alternatives to opioid medications is important and patients should be able to speak freely to their providers about their concerns.

References:

  1. Hackworth JC, Schneider JE, Do Valle M, et al. The burden of acute pain in the US in the wake of the opioid crisis. Front Pain Res (Lausanne). Published online October 7, 2025. doi:10.3389/fpain.2025.1642035
  2. Porter R, Barnett J, Blazar M, Pinheiro S, Bowlby L. Addressing the opioid crisis: a dynamic case-based module set for interprofessional educators, learners, and clinicians. MedEdPORTAL. 2022;18:11238. doi:10.15766/mep_2374-8265.11238
  3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep. 2022;71(3);1-95. doi:dx.doi.org/10.15585/mmwr.rr7103a1
  4. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408. doi:10.2147/JPR.S55598
  5. Lim JZM, Burgess J, Ooi CG, et al. The peripheral neuropathy prevalence and characteristics are comparable in people with obesity and long-duration type 1 diabetes. Adv Ther. 2022;39(9):4218-4229. doi:10.1007/s12325-022-02208-z
  6. Budiansky AS, Eipe N. Acute pain management in patients with severe obesity. Br J Anaesth. 2024;24(9):318-325. doi:10.1016/j.bjae.2024.04.006
  7. Baumann L, Bello C, Georg FM, et al. Acute pain and development of opioid use disorder: patient risk factors. Curr Pain Headache Rep. 2023;27(9):437-444. doi:10.1007/s11916-023-01127-0
  8. Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery. Arch Intern Med. 2012;172;(5):425-430. doi:10.1001/archinternmed.2011.1827
  9. Caplan M, Friedman BW, Siebert J, et al. Use of clinical phenotypes to characterize emergency department patients administered intravenous opioids for acute pain. Clin Exp Emerg Med. 2023;10(3):327-332. doi:10.15441/ceem.23.018
  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  11. Dydyk AM, Jain NK, Gupta M. Opioid use disorder: evaluation and management. [Updated 2024 Jan 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
  12. Matos A, Bankes DL, Bain KT, et al. Opioids, polypharmacy, and drug interactions: a technological paradigm shift is needed to ameliorate the ongoing opioid epidemic. Pharmacy. 2020;8(3):154. doi:10.3390/pharmacy8030154
Rita Aghjayan, MD

Rita Aghjayan, MD, received her medical degree from St. George’s University School of Medicine and has a strong interest in interventional cardiology. She is a former medical editor for The Clinical Advisor and Hematology Advisor. She also has extensive undergraduate and graduate research experience in nanophysics and microbial ecology at Pace University in New York City.

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