Pulling your wisdom teeth?
You don’t need opioids to deal with withdrawal pain, a new study says.
A combination of ibuprofen and acetaminophen provided better pain relief than hydrocodone with acetaminophen for the first two days after wisdom tooth surgery, researchers reported Thursday JAMA Network Open.
Both men and women also had greater satisfaction after surgery when using over-the-counter pain relievers compared with opioids, the researchers said.
The sex-related results are important because women consistently report higher levels of pain after surgery, the researchers said.
“We wanted to determine whether the effects of the pain medication were consistent in men and women separately,” said the lead researcher. Dr. Janine Fredericks-Youngerassociate professor at Rutgers School of Dental Medicine in Newark, New Jersey.
“And what we found is that in both subgroups (men and women), the non-opioid was superior for that first day and night, and then it was no worse than the opioid for the rest of the period after surgery,” Fredericks-Younger said in a news release.
For the clinical trial, researchers recruited more than 1,800 men and women who were scheduled to undergo wisdom teeth extractions, a painful procedure that requires cutting into the gums and sometimes removing bone.
Such dental procedures are how many Americans know about opioids, the researchers said in background notes. Dentists wrote more than 8.9 million opioid prescriptions in 2022.
“There are studies out there that show that when young people are introduced to opioids, as many are through the extraction of wisdom teeth, there is an increased likelihood that they will eventually use them again, and then it can lead to addiction,” Fredericks-Younger said.
About half of the trial participants received 400 milligrams of ibuprofen (Advil, Motrin) and 500 milligrams of acetaminophen (Tylenol) for their pain, the study says, the other half received 5 milligrams of hydrocodone with 300 milligrams of acetaminophen.
Patients monitored their pain twice a day for nine days using electronic diaries, noting not only their pain but also their sleep quality, ability to perform daily activities and overall satisfaction.
On every measure, the over-the-counter drugs matched or beat the opioid, including better sleep and less interference with daily activities, the study found.
Those prescribed opioids were also twice as likely to request additional pain medication, the researchers found.
“The results actually came out even stronger than we thought,” senior researcher Dr. Cecil Feldman he said in a press release. He is dean of the Rutgers School of Dentistry.
“We expected to find that non-opioid is non-inferior, so at least it’s not worse than opioids,” he said. “We were surprised to see that it was actually superior.”
These results should curb the common dental practice of writing opioid prescriptions “just in case” for patients who are told to start on over-the-counter drugs, the researchers said.
The American Dental Association already recommends against opioids as a first-line treatment for pain, the researchers noted.
“How can we now, with the evidence and knowledge we have, eliminate these prescriptions from being written?” Fredericks-Younger said.
Although this study focused on wisdom tooth extractions, Feldman said the findings could be applied to other dental procedures.
“We feel pretty confident in saying that opioids should not be routinely prescribed for dental procedures,” he said. “Our opioid-free combination should really be the analgesic of choice.”
However, future studies are needed to see if the same is true for other types of surgeries, particularly those to treat orthopedic injuries, Feldman added.
More information
The US Centers for Disease Control and Prevention has more dental pain management.
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