Acute pain
Pain in response to tissue damage, surgery or acute inflammation. Duration does not exceed 3 months. Treatment aims at rapid relief tailored to intensity and cause.
ICD-10 R52.05 drugs
Also known as: Acute pain syndrome
Drugs used for this condition
- BMetamizole sodiumSecond line · Analgesics and antipyretics. PyrazolonesMetamizole is used as an analgesic for acute pain of moderate to high intensity, particularly colic (renal, biliary), postoperative pain and when NSAIDs are contraindicated due to GI or cardiovascular risk. RCTs show efficacy comparable to paracetamol and ibuprofen. Due to agranulocytosis risk, the drug was withdrawn from the US market (1977), UK (2003), Sweden (1999) and Japan. It remains available in Russia, Germany, Brazil and Spain, with prescription status varying.
- BOxycodoneThird line · Semi-synthetic opioid analgesic (μ-agonist)Severe acute pain uncontrolled by non-opioid analgesics or weak opioids: postoperative pain, severe trauma, acute breakthrough cancer pain, renal colic refractory to NSAIDs. Per SED 2024 and SEMERGEN 2023 – third-line after paracetamol, NSAIDs, and weak opioids. Dose: 5–10 mg every 4–6 hours (immediate release) or 10–20 mg every 12 hours (controlled release). Short course ≤7 days outside oncology. Taper at discontinuation to avoid withdrawal.
- BTramadol + ParacetamolSecond line · Fixed-dose combination: weak opioid with SNRI activity plus non-opioid analgesicModerate acute pain in adults when paracetamol or an NSAID alone is not enough. The combination is a reserve, not a first choice: for acute nociceptive pain NSAIDs or paracetamol come first and outrank opioid combinations in network meta-analyses. Dose matters: the registered fixed 37.5/325 was no better than placebo for dental pain (network meta-analysis, J Dent Res 2023), whereas a clinically meaningful effect at the level of ibuprofen 400 mg is shown at 75/650, two tablets (Edwards 2002 IPD meta-analysis). Keep courses short, up to 5 days; watch for serotonin syndrome with antidepressants.
- DNimesulideSecond line · Antiinflammatory and antirheumatic agents, non-steroids. Other NSAIDsIn 2011, the EMA restricted nimesulide to short courses of up to 15 days for acute pain in adults. The drug has never received FDA approval. Finland, Spain, Ireland and Belgium withdrew the drug due to fulminant hepatic failure cases. In Russia, it remains available OTC, which is out of step with European practice. For acute pain, use is limited to short episodes when classic NSAIDs or paracetamol are ineffective or not tolerated.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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