Postoperative opioid use falls with EHR-guided pain care

Clinical takeaway: Ask patients about preferred nonmedication pain strategies before surgery and reinforce those choices throughout recovery. In this trial, embedding that approach in routine care reduced opioids given in the hospital and prescribed at discharge, while patients reported similar pain interference and physical function.

Opioids remain an important option after surgery, but perioperative teams also need practical ways to make nonmedication pain care part of routine treatment. The NOHARM trial tested an approach built into the electronic health record (EHR).

Across 22 surgical practices, the trial included 68,141 procedures. Before surgery, patients in intervention practices received a guide explaining opioid risks and inviting them to choose their preferred nonmedication pain strategies, such as walking, paced breathing, music, or heat and cold. EHR prompts helped nurses and therapists reinforce those choices during hospitalization and at discharge.

The program did not improve the trial’s primary outcomes: patients reported similar pain interference and physical function during the first three months after surgery in intervention and usual care periods.

However, total opioid exposure, a prespecified secondary outcome, was about 10% lower with the program, corresponding to an adjusted difference of approximately 260 morphine milligram equivalents per patient. Opioid administration during hospitalization and prescribing at discharge were lower. Prescribing after discharge did not differ significantly. At three months, fewer patients reported receiving more than three opioid prescriptions (3.3% vs 4.5%), but a similar proportion in each group reported taking opioids.

The study could not identify which parts of the intervention drove the reduction, and it did not establish that patients had fewer opioid-related harms. Future research could test whether more tailored support also improves pain and function.

“Scalable, EHR-embedded, system-level approaches embedded within routine clinical workflows may contribute to safer postoperative pain management,” the study authors concluded.

Source: Cheville AL, et al. (2026 Sep 25) JAMA Netw Open. Integrating nonpharmacological options into perioperative pain care: A cluster randomized clinical trial