Abstract Acute pain management is an important consideration in trauma and surgery patients. Inadequate management results in increased in-hospital complications, as well as increased risk of chronic pain and a diminished quality of life [1,2]. Acute pain is the symptom of greatest concern among patients undergoing elective surgery, and according to inpatient hospital surveys, ranks among the top three least desired outcomes [3,4]. In 1996, the American Pain Society (APS) described pain as the “5th vital sign” in an effort to emphasize the importance of pain assessment, which led the Veterans Health Administration to incorporate this approach into their national pain management strategy and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to introduce standards which elevated the priority of pain assessment and management (NPC). Opioid-based pharmacotherapy has long been the standard of care for acute pain management in trauma and surgical patients due to a perceived lack of viable alternative therapies, despite the well-known significant adverse effects of these agents, including pruritus, nausea, constipation, ileus, physical and psychological dependence, over-sedation, and life-threatening respiratory depression [5]. Since the implementation of pain as the 5th vital sign, opioid prescriptions and opioid-related deaths have quadrupled (CDC) [6,8]. In 2014, approximately two million Americans abused or were dependent on prescription opioids, and approximately 25% of patients who received prescription opioids for chronic non-cancer related pain, struggled with addiction [9]. Opioid addiction is now recognized as a significant public health burden in the United States, prompting the Center for Disease Control and Prevention (CDC) to call for improved opioid prescribing practices. In response to the opioid overdose epidemic, the American Medical Association (AMA) has recently opposed the use of pain as a 5th vital sign and has since returned to treating pain as a symptom [6].