Relative Efficacy and Safety of Opioid Versus Nonopioid Analgesics

Objectives: Analgesic use to reduce pain is an integral part of dental practice. We conducted a rapid review, examining the relative safety and efficacy of opioid and nonopioid oral analgesics for management of acute dental pain in adults.
Methods: A search was performed via PubMed Clinical Queries for Systematic Reviews. Three 2015 Cochrane “overviews of reviews” on single-dose acute pain management in adults were found—one on efficacy of analgesics in acute postoperative pain, one on adverse effects (AEs), and one on efficacy and safety for nonprescription analgesics. With pain relief, number needed to benefit (NNTB) is the number of people who must be treated to achieve clinically meaningful benefit of 50% pain relief in one additional patient. NNTB is calculated as the inverse of the absolute risk reduction. Lower NNTB indicates greater efficacy.
Results: Better NNTBs (<2) were found for combinations of ibuprofen and acetaminophen (1.5 or 1.6) and the single-agent nonsteroidal anti-inflammatory drugs (NSAIDs) diclofenac and ketoprofen (1.9 and 2.0).

AE risk ratios were not significantly different for placebo and single doses of NSAIDs, acetaminophen, and nonopioid drug combinations. Higher doses of aspirin; opioids; and fixed-dose combinations containing opioids were associated with significantly greater risk of AE than placebo.

The nonprescription review found the lowest NNTBs (<2) for ibuprofen/acetaminophen. Analgesics with values ~2 included ibuprofen (200 mg, 400 mg), ibuprofen 200 mg plus caffeine, and diclofenac potassium 50 mg.
Conclusions: Efficacy of NSAIDs, alone or in combination with acetaminophen, was greater than that of opioid-containing combinations. AE risk ratios with NSAIDs were not statistically different from placebo while those for opioid-containing regimens were statistically different from placebo. As current best evidence indicates superior analgesic efficacy and better AE profile for NSAIDs, alone or in combination with acetaminophen, compared with opioids, dentists should consider NSAIDs as first-line therapy for acute pain management.