Effect of Analgesic Stewardship Interventions on Pain Intensity Outcomes Assessed Using Validated Pain Scales: A Narrative Review

Author

Amulya Swamy Gowda, Sheba Baby John, Bettaswamy Huraliganaganahalli Vykuntappa, Preetham Gowda Chujjalakyathanahalli Manjunath, Kushi Sanjay, Shama Ramesh, Hanumantachar Joshi

Abstract

 Background: Effective pain management remains a critical component of perioperative and postoperative care. However, conventional analgesic practices, particularly the overreliance on opioid medications, have raised concerns regarding adverse drug events, opioid dependence, and variability in prescribing practices. Analgesic stewardship has emerged as a multidisciplinary, evidence-based approach aimed at optimizing analgesic utilization while maintaining adequate pain control. This review examines the impact of analgesic stewardship interventions on patient-reported pain outcomes and related clinical measures.

Objective: To critically evaluate the available evidence regarding the effectiveness of analgesic stewardship interventions, including multimodal analgesia protocols and Enhanced Recovery After Surgery (ERAS) pathways, on pain intensity outcomes measured using validated assessment tools and related postoperative recovery parameters.

Methods: A narrative review was conducted using a comprehensive literature search of the PubMed database for studies published between January 2026 and April 2026. Search terms included combinations of pain management, analgesic stewardship, opioid stewardship, multimodal analgesia, ERAS, Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and pain intensity. Eligible studies evaluated protocol-based analgesic stewardship interventions and reported quantitative pain-related outcomes. Data were narratively synthesized according to intervention type and clinical impact.

Results: Eight studies met the inclusion criteria, encompassing retrospective cohort studies, randomized controlled trials, prospective observational studies, and implementation-based evaluations. The evidence consistently demonstrated that multimodal analgesia and ERAS-based stewardship interventions were associated with effective pain control, reduced opioid consumption, and improved postoperative recovery. Opioid-sparing strategies incorporating non-opioid analgesics and adjunctive therapies maintained or improved patient-reported pain outcomes while minimizing opioid-related burden. Implementation-focused studies highlighted the importance of protocol adherence, multidisciplinary collaboration, and continuous monitoring for the successful integration of stewardship practices. Although some adjunctive pharmacological interventions showed limited additional benefit within optimized ERAS pathways, the overall evidence favored structured, protocol-driven approaches to pain management.

Conclusion: Analgesic stewardship interventions, particularly multimodal analgesia protocols and ERAS pathways, represent effective strategies for optimizing pain management while promoting safer and more rational analgesic use. These approaches can improve patient-centered outcomes and reduce opioid reliance without compromising analgesic efficacy. Nevertheless, the current evidence base is limited by methodological heterogeneity and inconsistent outcome reporting. Future high-quality prospective studies employing standardized pain assessment tools are needed to strengthen the evidence and support the development of evidence-based analgesic stewardship guidelines.

Keywords

Analgesic stewardship; Multimodal analgesia; Enhanced Recovery After Surgery; ERAS; Opioid stewardship; Pain intensity; Visual Analogue Scale; Numeric Rating Scale; Postoperative pain; Narrative review.

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