This is a secondary analysis of a previous multicenter, randomized clinical trial in which 207 patients with acute unstable chest wall injuries were randomized to receive either operative treatment (n=108) or non-operative treatment (n=99). The data for 200 patients was available in order to evaluate pain and post-injury opioid requirements, assessed through the daily morphine milligram equivalents (MME) used in-hospital, generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Outcomes were assessed over the first 14 days of hospitalization. Overall, the results of the study revealed no significant difference in opioid usage or pain symptoms between the two groups (p=0.477). This study suggests that operative treatment for these injuries does not reduce in-hospital pain or opioid requirements.