Dental Pain and Opioid Alternatives
Let’s face it, a toothache can be very painful. And sometimes pain following a dental procedure is unavoidable. Surprisingly enough however, opioids have not been found to be the best course of treatment for that pain. A recent review of more than 460 published studies conducted by researchers from several dental schools and the ADA revealed that opioids are not among the most effective or longest-lasting options available for relief from acute dental pain.
Instead the researchers found that ibuprofen and other NSAIDS (nonsteroidal anti-inflammatory drugs), alone or with acetaminophen, are better at combating dental pain overall. The data revealed that not only did more adult patients experience maximum pain relief from the over-the-counter medications, they also experienced far less unpleasant side effects associated with opioid use. The most adverse side effects, including drowsiness, respiratory depression, nausea, vomiting, and constipation, were attributed to opioids or combinations that included opioids.
The purpose of the research was to summarize the available evidence on the benefits and harms of analgesic agents, and was conducted in response to a request from the American Dental Association (ADA) Council on Dental Practice. It summarized data using five in-depth studies of the effectiveness of medications for oral pain.
The national opioid crisis is a topic of great concern and discussion recently, and according to the NIH (National Institutes of Health), more than 115 Americans die as the result of an opioid overdose each day. In addition, the NIH reports:
- Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
- 8% to 12% of opioid users develop a disorder.
- 4% to 6% of those who misuse prescription opioids transition to heroin
- About 80% of heroin users first misused prescription opioids
- Opioid overdoses in large cities increased by 54 percent in 16 states.
Anita Aminoshariae, DDS, MS, an associate professor in the Case Western Reserve University School of Dental Medicine’s Department of Endodontics and one of the study’s authors, suggests that prescribing narcotics should be a last resort. “No patient should go home in pain. That means that opioids are sometimes the best option, but certainly should not be the first option. The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.”*
The study, “Benefits and harms associated with analgesic medications used in the management of acute dental pain,” was published by the Journal of the ADA.