IADR Abstract Archives
Acute Pain Management with Combination Non-Opioid Containing Analgesics
Objectives: Opioid abuse is a current public health issue with dentists being one of the top opioid prescribers for adolescents and young adults. The goal of this pilot clinical trial is to compare over-the-counter ibuprofen with acetaminophen (NON-OPIOID) to Vicodin (OPIOID) to manage acute post-operative pain after impacted third molar extractions.
Methods: After IRB approval, 24 patients with at least 1 bony impacted mandibular molar were enrolled and randomly assigned to analgesic treatment group (OPIOID vs. NON-OPIOID). Participants took assigned analgesic immediately after the procedure was completed and then four times per day as needed for pain. If insufficient relief was obtained after an hour, patients could take another dose. Subjects were asked to record pain levels, analgesics taken, ability to sleep and daily function in a diary between extraction and post-operative visit one week later.
Results: All subjects completed study. Mean pain NRS was 3.62 for NON-OPIOID vs. 4.81 for OPIOID (0-9 scale; lower number indicating less pain). Descriptive and comparative statistical analysis (Mann-Whitney U and Fisher’s Exact) was performed. Mean ability to sleep was 4.09 for NON-OPIOID vs. 5.33 for OPIOID (0-9 scale; lower numbers indicating better sleep) and mean daily function was 1.55 for NON-OPIOID vs. 1.85 for OPIOID (1-4 Likert scale; lower numbers indicating better daily function). 25% less tablets were taken by NON-OPIOID. Adverse events were also lower for NON-OPIOID patients (59 vs. 95 reported adverse events). Due to small sample size, differences were not statistically significant.
Conclusions: NON-OPIOID outcomes exceled over OPIOID in all outcome dimensions including less pain, better sleep, better ability to function, greater satisfaction and fewer adverse events. Fewer NON-OPIOID tabs were required to successfully manage pain. A large scale pragmatic trial may clearly demonstrate that NON-OPIOID is at least as good, if not better, than OPIOID and have a significant public health impact.
Methods: After IRB approval, 24 patients with at least 1 bony impacted mandibular molar were enrolled and randomly assigned to analgesic treatment group (OPIOID vs. NON-OPIOID). Participants took assigned analgesic immediately after the procedure was completed and then four times per day as needed for pain. If insufficient relief was obtained after an hour, patients could take another dose. Subjects were asked to record pain levels, analgesics taken, ability to sleep and daily function in a diary between extraction and post-operative visit one week later.
Results: All subjects completed study. Mean pain NRS was 3.62 for NON-OPIOID vs. 4.81 for OPIOID (0-9 scale; lower number indicating less pain). Descriptive and comparative statistical analysis (Mann-Whitney U and Fisher’s Exact) was performed. Mean ability to sleep was 4.09 for NON-OPIOID vs. 5.33 for OPIOID (0-9 scale; lower numbers indicating better sleep) and mean daily function was 1.55 for NON-OPIOID vs. 1.85 for OPIOID (1-4 Likert scale; lower numbers indicating better daily function). 25% less tablets were taken by NON-OPIOID. Adverse events were also lower for NON-OPIOID patients (59 vs. 95 reported adverse events). Due to small sample size, differences were not statistically significant.
Conclusions: NON-OPIOID outcomes exceled over OPIOID in all outcome dimensions including less pain, better sleep, better ability to function, greater satisfaction and fewer adverse events. Fewer NON-OPIOID tabs were required to successfully manage pain. A large scale pragmatic trial may clearly demonstrate that NON-OPIOID is at least as good, if not better, than OPIOID and have a significant public health impact.