Pharmacological management of acute nociceptive pain

Abstract

Acute nociceptive pain is one of the main causes of seeking medical care, and its inadequate management may lead to chronicity and negatively impact functional recovery. This update provides a critical, evidence-based review of the pharmacological treatment of acute pain, focusing on a multimodal, individualized approach. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of therapy for mild to moderate pain, and the choice between non-selective NSAIDs and selective cyclooxygenase (COX)-2 inhibitors is guided by the patient’s gastrointestinal and cardiovascular risk profile. Topical NSAIDs represent an effective and safe alternative for localized musculoskeletal pain. Short-acting opioids are reserved as rescue therapy for severe and refractory pain and should be prescribed at the lowest effective dosage and for the shortest possible duration, with a clear tapering strategy. The application of these drugs is discussed in common settings, such as orthopedic trauma and postoperative pain, and in specific populations, including older individuals, pregnant women, and patients with renal or hepatic comorbidities, who require individualized dosage adjustments to ensure safety. The implementation of rational analgesic use is fundamental to maximizing pain relief, minimizing adverse effects, and preventing medication misuse, thereby effectively relieving suffering and optimizing clinical outcomes.