Can I receive an additional refill of Percocet (oxycodone/acetaminophen) for my acute shoulder pain, given I am an otherwise healthy adult without liver disease, opioid dependence, or acetaminophen contraindications, after a 5‑day supply on [date]?

Should an Additional Refill of Percocet Be Provided for Acute Shoulder Pain After a 5-Day Supply?

No, an additional refill of Percocet (oxycodone/acetaminophen) should not be provided for acute shoulder pain beyond the initial 5-day supply, as current CDC guidelines explicitly state that 3 days or less is often sufficient for acute pain and more than 7 days will rarely be needed. 1

Guideline-Based Duration Limits

The 2022 CDC Clinical Practice Guideline establishes clear boundaries for opioid prescribing in acute pain:

• Three days or less will often be sufficient for acute pain management 1
• More than 7 days will rarely be needed for acute non-traumatic, non-surgical pain 1
• Clinicians should not prescribe additional opioids "just in case" pain continues longer than expected 1
• The subset of patients experiencing severe acute pain beyond expected duration should be reevaluated to confirm or revise the initial treatment plan rather than automatically receiving refills 1

Appropriate Next Steps Instead of Refilling

Reassessment Required

• Reevaluate the patient to determine why pain persists beyond the expected 5-day course 1
• Confirm the original diagnosis and assess for complications or alternative diagnoses that may require different interventions 1
• Evaluate whether the patient experienced adequate pain relief with the initial prescription or if the dosing was suboptimal 1

Transition to Nonopioid Therapies

• Maximize nonopioid pharmacologic options including NSAIDs (ibuprofen, naproxen) and acetaminophen alone for ongoing shoulder pain 1, 2
• Implement nonpharmacologic interventions such as ice, heat, immobilization, or physical therapy appropriate for shoulder injuries 1, 2
• Nonopioid therapies are at least as effective as opioids for many common musculoskeletal injuries including shoulder pain 1, 2

Critical Safety Considerations

Acetaminophen Toxicity Risk

• If the patient received a 5-day supply at typical dosing (2 tablets every 6 hours), they consumed 6,500 mg of acetaminophen daily, approaching the maximum safe limit 2
• Continuing this regimen increases risk of hepatotoxicity, particularly if the patient is using other acetaminophen-containing products 2, 3
• Research demonstrates that 8.1% of opioid-acetaminophen prescriptions exceed recommended daily acetaminophen limits, putting over 255,000 patients at risk annually 3

Opioid Dependence and Tolerance

• Long-term opioid use often begins with treatment of acute pain 1
• Prescribing beyond 7 days for acute pain increases risk of chronic opioid use and dependence 1
• Patients should use opioids only as needed (PRN) rather than scheduled to minimize total exposure 1, 2

When Additional Opioids Might Be Justified

The CDC acknowledges limited scenarios where opioids beyond 7 days may be appropriate:

• Severe traumatic injuries including crush injuries or burns 1
• Invasive surgeries with moderate to severe postoperative pain 1, 2
• Contraindication to NSAIDs (e.g., active GI bleeding, severe renal impairment, cardiovascular disease) 1

For shoulder pain specifically, these circumstances are rarely applicable unless there was severe trauma or surgical intervention 1.

Common Pitfalls to Avoid

• Do not reflexively refill opioid prescriptions without reassessing the patient and exploring nonopioid alternatives 1
• Do not assume that requesting additional medication indicates inadequate initial dosing rather than expected resolution timeline 1
• Do not fail to account for total acetaminophen exposure from all sources when the patient has been taking combination products 2, 3
• Do not prescribe extended-release formulations for acute pain, as these are indicated only for opioid-tolerant patients with chronic pain 2

Alternative Management Algorithm

If pain persists after 5 days:

1. Reassess clinically for complications (rotator cuff tear, fracture, infection) 1
2. Transition to scheduled NSAIDs (e.g., naproxen 500 mg twice daily) if not contraindicated 1, 2
3. Add acetaminophen alone (650 mg every 6 hours) for multimodal analgesia 1, 2
4. Implement physical therapy and activity modification 1
5. Consider specialist referral (orthopedics, pain management) if pain remains severe beyond 7-10 days 1