Researchers at the Eastman Institute for Oral Health investigated the use of a gabapentin combination as a non-opioid replacement for people who cannot take ibuprofen or acetaminophen.
As the opioid epidemic continues throughout the COVID-19 epidemic, new research from the University of Rochester Medical Center's Eastman Institute for Oral Health (EIOH) provides hope for non-opioid treatments for acute dental pain.
Between 2019 and 2020, the percentage of deaths involving prescription opioids increased by more than 16%, accounting for roughly 18% of all opioid overdose fatalities.
The research, published in JAMA Network Open, examines two large patient groups that include an equal number of men and women between the ages of 18 and 93 who had tooth extractions at the Institute's Howitt Urgent Dental Care clinic in Rochester, New York.
Yanfang Ren, DDS, MPH, professor and clinical director of Howitt Urgent Dental Care, believes using a combination of non-opioid pain medications and including gabapentin to the dosage for pain would be an effective strategy to minimize or eliminate opioids for dental discomfort.
In the 3,300 individuals who participated in the first group in 2012, ibuprofen or opioid combinations, such as hydrocodone, oxycodone, or codeine, were used to manage mild to severe pain.
Despite the fact that the second group of about 3,800 patients who had extractions between March 2021 and February 2022 received no opioids at all.
For mild to severe pain, the second group received the same acetaminophen or ibuprofen prescriptions. Higher ibuprofen dosages or an ibuprofen and acetaminophen combination were given.
Individuals who were unable to take ibuprofen or acetaminophen owing to health problems or potential complications with current prescriptions were often prescribed an opioid combination in 2012. However, in 2022, a gabapentin combination was used as a non-opioid alternative. When the efficacy was evaluated using a real-world experiment of the percentage of patients returning for further pain treatment after receiving the prescribed medications, the results were promising.
“Dentists often prescribe opioids for dental discomfort, because they contribute to new and persistent opioid use,” said Dr. Ren. This may partly be related to the absence of alternative medications, especially when the ibuprofen or acetaminophen are ineffective or cannot be tolerated.
“This study indicates the ongoing effort of our team and other dentists to minimize the use of opioids for dental pain,” said Eli Eliav, DDS, Ph.D., the director of EIOH and a pain expert. “Additional studies, preferably randomized controlled clinical trials, are required to verify the safety and effectiveness of this approach. Patients in pain should continue to seek safe and effective treatment.”
Qirong Huang, DDS, MS, Linda Rasubala, DDS, Ph.D., Junad Khan, BDS, MPH, Ph.D., Eli Eliav, DMD, Ph.D., and Yanfang Ren, DDS, Ph.D., JAMA Network Open, 17 August 2022. DOI: 10.1001/jamanetworkopen.2022.27219