Rettig EM, Janus JR, Moore EJ, et al. - In this retrospective cohort study involving 445 patients [median age was 60 years (interquartile range 50–68)], researchers sought to describe pain experience and opioid use after major head and neck reconstructive surgery. Participants in the study were patients undergoing major head and neck surgery with microvascular free tissue transfer (free flaps) at a tertiary academic center. Pain scores (0–10) and demographic and clinical data have been ascertained from medical records. Continued use of opioids after discharge is common among patients undergoing major reconstruction of the head and neck, especially in younger patients and following more extensive surgery. Older patients recorded significantly lower pain scores while patients with opioid tolerance, anxiety, current smokers, and those with larger volume resections or boney free flaps recorded significantly higher pain scores. Older patients reported lower pain intensity and were less likely to receive opioid refills, highlighting the wisdom of careful opioid use in this vulnerable population.