Opioids or NSAIDS? Current Pain Management Best Practices, with Shoshana Herzig, MD, MPH

Effective pain management remains a cornerstone of inpatient care, yet practice patterns often vary widely—and not always in ways that reflect current evidence. Despite the availability of multiple pharmacologic options, many clinicians default to familiar regimens rather than tailoring treatment based on safety, efficacy, and patient-specific factors.

Shoshana Herzig, MD, MPH, Associate Professor of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, gave a talk at the American College of Physicians (ACP) Internal Medicine (IM) Meeting 2025, held April 3-5, in New Orleans, Louisiana, reviewing current best practices and the most updated data supporting strategies for effective and safe acute inpatient pain management.

“One of the main messages in my talk… is to remind people that NSAIDs are over the counter for a reason and opioids are not over the counter for a reason, and I think we need to kind of recalibrate our perceptions of risks and benefits as they relate to NSAIDs versus opioids,” Herzig told HCPLive during the meeting. “There's been some emerging data that does support the assertion that we should use NSAIDs more often.”

HCPLive sat down with Herzig during the conference to learn more about the latest strategies for managing pain, as validated by the literature. She stressed the importance of ensuring consistent pain management strategies between centers and clinicians and also noted widespread, unnecessary NSAID-avoidance by many practitioners, although its use is supported by data. She outlined some recent findings of opioid compared with non-opioid pain management strategies, although she also said that more studies would be beneficial to strengthen the currently available data.

Herzig has no disclosures to report.

REFERENCE

Herzig S. Acute Pain Management in the Inpatient Setting. Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.