Pharmacologic strategies for managing acute pain

Acute pain, characterized by its short duration and association with tissue damage, requires tailored pharmacologic management to prevent the transition to chronic pain. This article discusses a tiered approach to acute pain management, primarily focusing on musculoskeletal and postoperative pain, with data supporting various pharmacologic interventions.

First-line treatments include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen is recommended for its safety profile, especially in patients with renal or hepatic impairment. NSAIDs are effective but require caution in patients with gastrointestinal, cardiovascular, or renal risks. Topical NSAIDs are preferred for non–low back musculoskeletal pain due to their localized action and minimal systemic absorption. Adjunctive medications like muscle relaxants can be useful for acute low back pain. For severe or refractory pain, short-term use of opioids or dual-action medications such as tramadol and tapentadol may be considered, with a strong emphasis on minimizing risk and duration of use.

Racial and ethnic disparities in pain management are significant, with minority patients often receiving inadequate pain treatment. It is crucial to apply pain management principles equitably across all patient groups to mitigate these disparities. Combinations of analgesics, such as ibuprofen and acetaminophen, have shown superior effectiveness and lower adverse effect rates compared to single agents. The article underscores the importance of nonpharmacologic treatments and regular reassessment to adjust therapy as needed.