A long-term study that took place at a New York dental clinic makes the strong case that giving patients nonopioid painkillers for dental pain is as effective as opioids, echoing a growing body of work—and messaging—that dentists should minimize prescribing opioids for pain.
Comparison of Analgesic Prescriptions for Dental Pain and Patient Pain Outcomes Before vs After an Opioid Reduction Initiative was published in JAMA Open Network and was the result of an opioid reduction initiative that was implemented in 2013 at the Howitt Dental Urgent Care Clinic at the University of Rochester Medical Center’s Eastman Institute for Oral Health. A multimodal analgesia strategy including gabapentin was initiated in 2020.
Although NSAIDs and acetaminophen have been shown to be more effective at reducing pain than opioid analgesics, opioids continue to be used more than nonopioids. This is potentially due to a lack of opioid alternatives, especially when NSAIDs or acetaminophen pose health issues or potential interactions with existing medications, according to the researchers.
According to a University of Rochester press release, for the 3,300 patients in the first group in 2012, those with mild pain were treated with ibuprofen or acetaminophen. Patients with moderate to severe pain were prescribed higher doses of ibuprofen or opioid combinations such as hydrocodone, oxycodone, or codeine.
But the second group of some 3,800 people who had extractions from March 2021 through February 2022 didn’t get opioids. In 2022, those patients who were unable to take ibuprofen or acetaminophen due to contraindications or lack of effectiveness were given a combination that included gabapentin. According to the study, gabapentin is not metabolized in the body and as such is safe in combination with other analgesics, such as acetaminophen or NSAIDs, providing a potential alternative to opioids, especially when acetaminophen/NSAIDs are contraindicated.
While researchers noted that additional studies are needed to confirm the safety and efficacy of this approach, the results of this one show potentially far-reaching effects of reducing or eliminating prescribing opioids for dental pain:
“Considering that 1,800 patients received more than 20,000 opioid pills annually in our clinic before implementation of the opioid reduction strategy, eliminating opioid prescriptions may mean that approximately 105 individuals annually will not develop new and persistent opioid use associated with treatment at our clinic.”
