Tuesday, 20 Nov 2018

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

Intensive Patient Education Does Not Improve Low Back Pain Care

JAMA reports on a randomized clinical trial of 202 adults with acute low back pain showing the addition of intensive patient education failed to improve pain outcomes.

This randomized, placebo-controlled clinical trial recruited patients from general practices in Sydney, Australia, between 2013 - 2015. Patients had to have acute low back pain of fewer than 6 weeks’ duration. 

Guidelines for Patellofemoral Pain

New recommendations have been published in the Journal of Athletic Training on the management of patellofemoral pain (PFP).

Complex Pain Syndromes in the Emergency Room

Emergency physician Chris Hahn, MD, doesn't have any trouble conjuring a simple definition of fibromyalgia. "Just think about the most annoying chief complaints you can imagine. That's the diagnostic criteria."

Carpal Tunnel Syndrome - a Leading Cause of Work Related Disability

MMWR reports that workers’ compensation claims for carpal tunnel syndrome (CTS) in California during 2007–2014 were 6.3 per 10,000 full-time equivalent workers, with female workers and workers in industries that manufacture apparel, process food, and perform administrative work being at highest risk for CTS.

Anxiety and Depression are Common in Arthritis Patients

The high prevalence of symptoms of anxiety and depression among adults with arthritis warrants awareness, screening, and subsequent treatment of these conditions. Health care providers can refer patients to mental health professionals and self-management education programs, and encourage physical activity to reduce anxiety and depression symptoms and improve quality of life.