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The Use of Opioid Analgesics in the Management of Acute and Chronic Orofacial Pain in Canada: The Need for Further Research
... 9,22 In the late 2013, a group was set up to participate in an orofacial pain workshop in Montreal, Canada, and all agreed that the use of opioid painkillers by dentists for acute and chronic oral pain had not been properly investigated in that country. 16,22 Existing literature suggested that the consumption of opioid analgesics for controlling acute pain var-r r ies from country to country. 16 In the UK in 2001, all prescriptions involving analgesics prescribed by dentists were further evaluated, showing the most commonly prescribed analgesic to be ibuprofen (70%). ...
... 16,22 Existing literature suggested that the consumption of opioid analgesics for controlling acute pain var-r r ies from country to country. 16 In the UK in 2001, all prescriptions involving analgesics prescribed by dentists were further evaluated, showing the most commonly prescribed analgesic to be ibuprofen (70%). 12 Drug abuse is a global dilemma and self-administered consumption of medications is increasing worldwide. ...
Purpose:
Analgesics (painkillers) are one of the most widely used medications to reduce and control pain. The objective of this study was to investigate the self-medication with analgesics (narcotic or non-narcotic) in controlling odontogenic pain in patients visiting dental offices, dental clinics, and the dental school of Kerman.
Materials and methods:
This was a descriptive-analytic study, conducted in 2018. The study sample included patients referring to dental offices, dental clinics and the dental school of Kerman. After obtaining informed consent, a questionnaire consisting of demographic data and questions regarding the consumption of different types of analgesics for relieving and controlling odontogenic pain and their impact on patients was given by the researcher to the respondents. The patients were asked to complete and return the forms. The questionnaire consisted of three categories of questions, including demographic data, pain characteristics (severity, aggravating factors, relieving factors, etc) and the drug used to relieve the pain. Pain severity was measured using a visual analogue scale (VAS). Mann-Whitney and chi-squared tests were used for statistical analysis in SPSS.
Results:
This study included 230 males and 351 females (male:female ratio = 0.66) in the age range of 18 to 71 years old (38.21 ± 7.45). 2.6% of respondents were illiterate and 11.3% of respondents were unemployed. The mean value of pain intensity was 6.21 ± 1.11 on a scale of 1 to 10. The types of drugs used for pain relief included 71.8% analgesics, 12.1% complementary medicines and 16.1% antibiotics. The most commonly used medication was NSAIDS, followed by acetaminophen codeine. In this study, the fourth most common medication consumed by patients as an analgesic was amoxicillin. Moreover, it showed that 44.3% (257 individuals) of study participants had used analgesics as self-medication to relieve odontogenic pain, of which 46.08% were males (N = 107) and 42.68% were females (N = 150). The gender of respondents, level of education, and occupation were significantly associated with the consumption of opioid drugs (p = 0.023, p = 0.041, p = 0.011, respectively). Consumption of opioid medications was not statistically significantly correlated with pain intensity (p = 0.115).
Conclusion:
The factors affecting the appropriate use of medications are social, economic, cultural, and flaws in the health-care system of a society. This study showed that the medications used to reduce pain included analgesics, traditional drugs, and antibiotics. The rate of self-medication was higher among men and among those having a higher level of education.
... It is considered to 2 Evidence-Based Complementary and Alternative Medicine be a conservative and valuable approach in the remission of TMD symptoms, often being associated with adjuvant therapies, such as pharmacological ones [10]. However, we have found an excessive use of allopathic medication, selfmedication, or prescription in TMD patients, leading to frequent side effects and adverse reactions [11]. ...
Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study) and the use of the occlusal splint plate alone (control). We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p < 0.05). However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p < 0.05) already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.
After reviewing this chapter, dental practitioners will be able to: Screen patients for substance use disorder and refer to treatment. Recognize schemes and scams used by patients in dental practices to divert prescription medications. Describe the purpose of the state prescription monitoring program. Analyze a prescription monitoring program report to make clinical decisions about prescribing controlled substances in practice. Educate patients about appropriate disposal of controlled substances. Describe universal precautions that should be used in prescribing controlled substances in a dental practice
Study objective:
In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior.
Methods:
After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older.
Results:
Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000).
Conclusion:
A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain.
Unlabelled:
Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related policies.
Perspective:
Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.
To compare the relative efficacy of analgesics after third molar extraction from systematic reviews of randomised, double blind studies.
Dental trials from systematic reviews of randomised, double-blind studies of analgesics in acute pain.
Number of patients with moderate or severe pain achieving at least half pain relief over 4 to 6 hours after a single oral dose of analgesic.
Independently by two reviewers.
Use of dichotomous information from active and placebo treatments, first to calculate the statistical significance using relative risk, and then to evaluate the clinical relevance using number needed to treat (NNT). Non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase-2 (COX-2) inhibitors had the lowest (best) NNTs for the outcome of at least half pain relief over 4-6 hours compared with placebo. With the best performing analgesics, 50-70 patients out of 100 had good pain relief compared with about 10 out of 100 with placebo. Only paracetamol 600/650 mg plus codeine 60 mg was associated with any significant increase in any patient experiencing an adverse event.
NSAIDs and COX-2 inhibitors have the lowest (best) NNTs. They may also have fewer adverse effects after third molar surgery, though conclusive evidence is lacking. At least 80% of analgesic prescribing by UK dentists is in line with the best available evidence on efficacy and safety.
It has been suggested that a source of narcotics used for nonmedical purposes by young adults is the unused opioids prescribed for the management of pain after the removal of impacted third molars. The purpose of the present study was to determine whether oral and maxillofacial surgeons routinely prescribe larger amounts of a narcotic than would generally be needed for adequate postoperative pain control. A secondary goal was to determine whether they use methods other than analgesic drugs to minimize postoperative pain and thereby reduce the amount of narcotic that might be needed.
An 8-question survey was sent to 100 randomly selected oral and maxillofacial surgeon members of the American Association of Oral and Maxillofacial Surgeons in each of the 6 association districts. The questions asked were related to whether a narcotic was routinely prescribed for patients who have had impacted teeth removed, the most common drug used, and the dosage and number of tablets prescribed. The participants were also asked whether they had pretreated patients with a nonsteroidal anti-inflammatory drug or had prescribed one along with the narcotic, had injected a steroid, or had used a long-lasting local anesthetic postoperatively.
Only 2 of the 384 respondents stated that they did not prescribe a narcotic for patients who had had impacted teeth removed. Hydrocodone (5 mg) was the most frequently prescribed narcotic. The number of tablets varied from 10 to 40, but the most common number was 20 tablets. However, 80 respondents (22%) prescribed more, with 40 prescribing 30 tablets. Also, 80% of the respondents injected their patients with a steroid, and 62% injected a long-lasting local anesthetic postoperatively. Only 34% pretreated their patients with a nonsteroidal anti-inflammatory drug, but 66% recommended such use postoperatively.
Most oral and maxillofacial surgeons prescribe analgesic drugs of an appropriate type and dosage and use proper adjunctive pain control measures to supplement these drugs. However, our findings also indicated that more than 20% prescribe more tablets than would generally be necessary to control the postoperative pain after the removal of impacted third molars. This could be a source of drug diversion and nonmedical use by young adults and should be avoided.
The long-term treatment of patients with chronic temporomandibular joint dysfunction has been challenging. The long-term use of opioids in these patients can be neither supported nor refuted based on current evidence. However, evidence is available to support the long-term use of opioids in other chronic noncancer pain states with reduced pain, improved function, and improved quality of life. One group of patients with chronic temporomandibular joint pain, for whom both noninvasive and invasive treatment has failed, might benefit from long-term opioid medication. The choices include morphine, fentanyl, oxycodone, tramadol, hydrocodone, and methadone. Adjunct medication, including antidepressant and anticonvulsant drugs, can also be used. The safety of these medications has been well established, but the potential for adverse drug-related behavior does exist, requiring appropriate patient selection, adequate monitoring, and intervention when needed.
We investigated disparities in the prescription of analgesics following dental procedures that were expected to cause acute postoperative pain. Patients over the age of 19 years who had been treated by surgical and/or endodontic dental procedures were included in this study. We reviewed 900 consecutive charts and abstracted data on procedures, patients, and providers. We used chi-square and logistic regression models for analyses. There were 485 White subjects, 357 African American subjects included in this review; 81% of the African American and 78% of White patients received a postoperative narcotic prescription (p = .56). In multivariate regression models, patients over age 45 (p = .003), those with insurance that covered medication and those with preexisting pain (p = .004) were more likely to receive narcotic analgesics. Students prescribed more narcotics than residents (p = .001). No differences were found by race in prescribing analgesics.
A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.