Nonopioids and multimodal analgesia better to manage postoperative dental pain: JAMA

Dentists frequently prescribe opioids for dental pain and contribute substantially to new and persistent opioid use. A group of researchers hypothesized that a multimodal analgesia strategy with NSAIDs, acetaminophen, and gabapentin would be associated with minimized use of opioids for dental pain.

This cross-sectional study was approved by the University of Rochester's institutional review board, which waived informed consent because data were anonymous and reviewed retrospectively. Frequencies of different analgesic prescriptions after tooth extractions were compared between the 2 periods. Descriptive statistics, χ2 tests, and relative risks (RRs) with 95% CIs were used to assess changes in patterns of analgesic prescriptions and differences in failure rates. Data were analyzed with OpenEpi, version 3.1. Two-sided P < .05 was significant

The results of the study are:

• A total of 3357 patients were prescribed analgesics after dental extractions in 2012 compared with 3785 in 2022.
• The rate of nonopioid multimodal analgesia use was higher in 2022 than in 2012 (7 [0.2%]).
• In all, 1166 patients (34.7%) received opioid combination analgesics after extractions in 2012.
• In 2022, no patients received opioids, but 1871 (49.4%) received acetaminophen/ibuprofen and 496 (13.1%) received gabapentin multimodal analgesia.
• Acetaminophen/ibuprofen had a failure rate (2.2%) significantly lower than that of gabapentin/acetaminophen or gabapentin/ibuprofen and that of opioids.
• The failure rate for multimodal analgesia including gabapentin was significantly lower than for opioids.

Thus, this study showed a shift in prescribing in the clinic from opioids and single-medication analgesics to nonopioids and multimodal analgesia to manage postoperative dental pain.

Reference:

Huang Q, Rasubala L, Gracely RH, Khan J, Eliav E, Ren Y. Comparison of Analgesic Prescriptions for Dental Pain and Patient Pain Outcomes Before vs After an Opioid Reduction Initiative. JAMA Netw Open. 2022;5(8):e2227219. doi:10.1001/jamanetworkopen.2022.27219

Keywords:

Comparison, Analgesic, Prescriptions, Dental Pain, Patient, Pain, Outcomes, Before, After, Opioid, Reduction, Initiative, Huang Q, Rasubala L, Gracely RH, Khan J, Eliav E, Ren Y, JAMA Netw Open