New study shows promising alternative to opioids for pain after tooth extractions

alternative to opioids
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A US study shows promise for a non-opioid alternative for acute dental pain.

Published in JAMA Network Open, the study by researchers at the University of Rochester Medical Center’s Eastman Institute for Oral Health (EIOH) compares two large groups of patients representing an equal number of men and women aged 18-93 who had dental extractions at the Institute’s Howitt Urgent Dental Care clinic in Rochester, New York.

“We hypothesised that using a combination of the non-opioid pain medications and adding gabapentin to the mix for pain would be an effective strategy to minimise or eliminate opioids for dental pain,” Dr Yanfang Ren said.

For the 3300 patients in the first group in 2012, those with mild pain were treated with ibuprofen or acetaminophen. For moderate to severe pain, patients were prescribed higher doses of ibuprofen or opioid combinations including hydrocodone, oxycodone or codeine.

But the second group of nearly 3800 people who had extractions from March 2021 through to February 2022 received no opioids whatsoever.

Similarly, for mild pain, the second group was prescribed acetaminophen or ibuprofen. For moderate to severe pain, higher doses of ibuprofen or an ibuprofen and acetaminophen combination were prescribed.

For the segment of patients who were unable to take ibuprofen or acetaminophen due to health issues or potential interactions with existing medications, they were often prescribed an opioid combination in year 2012, but a gabapentin combination was used instead in 2022 as a non-opioid alternative. 

The results were promising when the effectiveness was evaluated using a real-word measure of the proportion of patients returning for additional pain treatment after receiving the prescribed analgesics.

“Dentists frequently prescribe opioids for dental pain and contribute substantially to new and persistent opioid use,” Dr Ren said.

“This may partly be explained by the lack of alternatives to opioids, especially when the ibuprofen or acetaminophen are ineffective or can’t be tolerated.”

Dr Eli Eliav added: “This study represents continued efforts by our team and other dentists to minimise the use of opioids for dental pain.”

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