Acute moderate-to-severe pain
Moderate-to-severe pain requiring prompt relief. Ketorolac is one of the most potent non-opioid analgesics. Treatment is strictly limited to 5 days.
ICD-10 R52.03 drugs
Also known as: Acute pain syndrome
Drugs used for this condition
- AKetorolacFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)First-line for acute moderate-to-severe pain when rapid non-opioid analgesia is needed. Oral dose is 10 mg every 4–6 hours, maximum 40 mg daily. Course is strictly limited to 5 days. Beyond 5 days, the risk of GI bleeding and renal injury rises sharply. Not indicated for chronic pain.
- AMorphineFirst line · Natural opium alkaloidsStandard for severe acute pain in hospital. IV 2–5 mg every 5–10 minutes to analgesia. In postoperative patients, patient-controlled analgesia (PCA) is used. Per CDC 2022, outpatient courses for acute pain should not exceed 3–7 days.
- BTramadolSecond line · Other opioidsPer the CDC 2022 Opioid Prescribing Guideline, tramadol is not first-line for acute pain – recommended as second-line after acetaminophen and NSAIDs fail. Modern meta-analyses (BMJ 2022, Wertli et al.) show tramadol effects in acute and chronic musculoskeletal pain are modest and comparable to NSAIDs, with worse safety due to dependence, sedation, and serotonin syndrome risk. Dose: 50–100 mg four times daily, max 400 mg/day. In patients over 75: max 300 mg/day.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit