Study: NSAIDs beat opioids for pain management

By Will Morton, DrBicuspid.com contributing writer

January 19, 2023 -- Nonsteroidal anti-inflammatory drugs (NSAIDs) resulted in better pain-related outcomes than opioids for acute pain management after tooth extractions, according to a recently published study in the Journal of Dental Research.

A team at McMaster University in Hamilton, Ontario, led by Anna Miroshnychenko conducted a systematic review and network meta-analysis to assess the comparative effectiveness of 10 different pharmacological interventions to manage pain following simple and surgical tooth extractions, as well as pain associated with pulpitis or its complications.

According to the findings, interventions classified as the most effective for pain relief were ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg, acetaminophen 650 mg plus oxycodone 10 mg, ibuprofen 400 mg, and naproxen 400 to 440 mg.

Further, NSAIDs with or without acetaminophen resulted in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo, the researchers found (J Dent Res, January 11, 2023).

"North America is amid an opioid crisis, which is a leading public health and safety concern. In dentistry, many patients are prescribed opioids for the first time to manage acute postoperative pain after dental impaction surgery, which often results in prescription of an excess number of opioid pills, thereby increasing the risk of misuse, abuse, and addiction," the American Association for Dental, Oral, and Craniofacial Research (AADOCR) said in a news release.

In addition, out of more than half a million dental patient visits between 2011 and 2015, 29% of prescribed opioids exceeded the recommended morphine equivalent for appropriate management of acute pain, and over half exceeded the recommended days of supply, the AADOCR noted.

The study was conducted to inform evidence-based clinical practice guidelines for the management of acute dental pain under development by the ADA's Council on Scientific Affairs, the ADA Science & Research Institute, and the University of Pittsburgh and the University of Pennsylvania schools of dental medicine in partnership with the U.S. Food and Drug Administration.

The new clinical practice guideline on the management of acute dental pain is expected to be published this year, according to the ADA.


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