Friday, 15 Feb 2019

You are here

NSAIDs and Acetaminophen Preferred Over Opioids for Dental Pain

A systematic review in the Journal of the American Dental Association evaluated the safety and efficacy of analgesics and foundp opioids less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen when treating dental pain.

A metanalysis narrowed down to 5 eligible studies, 2 included a pediatric population. The data suggests that NSAIDs, with or without acetaminophen, offers the best efficacy and safety, especially when compared to opioids. This is for magnitude and duration of pain relief.

Medication and medication combinations with the longest duration of action, meaning that they had the longest time before rescue remedication was requested, was 10.9 hours for 1,000 mg of diflunisal, 9.9 hours for 650 mg of acetaminophen and 10 mg of oxycodone, 9.8 hours for 500 mg of diflunisal, and 8.9 hours for 500 to 550 mg of naproxen. The medications and medication combinations that provided the shortest duration of pain relief were 3.5 hours for 600 to 650 mg of acetaminophen, 3.1 hours for 25 mg of diclofenac potassium, 2.7 hours for 60 mg of codeine, and 2.4 hours for 250 mg of gabapentin.

By contrast studies show that opioids or opioid drug combinations had more acute adverse side effects--including drowsiness, respiratory depression, nausea/vomiting and constipation--in both children and adults.

From a risk: benefit perspective, these data make it hard to justify the use of opioids as first line analgesia for dental pain and procedures. Nonsteroidal anti-inflammatory drugs, with or without acetaminophen, is equal or superior to that provided by opioid-containing medications.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Pain Drives the Use of Medical Marijuana

A report from the University of Michigan examined state-wide medical marijuana showing most of it is used for chronic pain.

The authors include Kevin Boehnke, Ph.D., Daniel J. Clauw, M.D., Rebecca L. Haffajee, Ph.D., and Saurav Gangopadhyay, M.P.H. undertook this investigation to to assess why people are using cannabis medically. 

Compounded Pain Creams - Expensive Placebos?

The Annals of Internal Medicine reports that the growth and use of compounded pain creams is unwarranted as they were no better than placebo in a randomized controlled trial, suggesting their higher costs are unjustifiable compared to other topical commercially available agents (lidocaine, diclofenac, capsaicin, etc.). (Citation source: https://buff.ly/2BkTj58)

Opioids Double Rates of Suicides and Overdoses

An article in the New England Journal of Medicine reports that the rates of suicide and drug overdoses has doubled in the last 17 years, and that opioids are largely to blame.

Using data from the Centers for Disease Control and Prevention databases, researchers show that the sheer number of deaths from suicides and unintentional overdoses together rose from 41,364 in the year 2000 to 110,749 in 2017.

Cryotherapy Never FDA Approved

Another injury related to whole body cryotherapy (WBC) has been reported by practitioners in Philadelphia, serving as yet another warning of WBC's potential to cause serious adverse effects.

Post-Approval Exploratory Trials with Pregabalin Often Fail

A systematic review of 238 pregabalin (Lyrica) trials for nonapproved indications shows that nearly two-thirds yielded uncertain evidence of efficacy, thereby questioning the off-label use or endorsement in clinical practice guidelines.