Evidenced Based Analgesic Efficacy in Post-Surgical Dental Pain Elliot V Hersh DMD, MS, PhD Professor Oral Surgery and Pharmacology University of Pennsylvania School of Dental Medicine Chair –IRB#3, Office of Regulatory Affairs University of Pennsylvania
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Evidenced Based Analgesic Efficacy in Post-Surgical Dental Pain
Elliot V Hersh DMD, MS, PhDProfessor Oral Surgery and Pharmacology
University of Pennsylvania School of Dental MedicineChair –IRB#3, Office of Regulatory Affairs
Barden J, Edwards JE, McQuay HJ, Moore RA. Pain 2004;107:86-90.
In response to placebo more than 60% of dental pain trials had less than 15%of their patients achieving 50% maximum pain relief compare to only 40% of otherpostsurgical pain models. In fact only 11% of dental pain trials had more than 30%of their patients achieving more than 50% pain relief from placebo compared to more than 30% of other postsurgical pain models.
Basic Principles Of Clinical Studies
Double-blindRandom allocation of treatment to subjectsInclusion of placebo Inclusion of standard treatmentsIdentical appearance of study medication
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PAIN
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ASPIRIN 650 mg(N=32)
ACETAMINOPHEN 650 mg(N=56)
PLACEBO(N=32)
PLACEBO(N=55)
Cooper, Oral SurgeryArch Intern Med 1981;141:282-285
Dionne RA, Campbell RA, Cooper SA, Hall DL, Buckinham B. J Clin Pharmacol 1983;:23:47-53.Dionne RA, Cooper SA. Oral Surg, Oral Med, Oral Pathol 1978;45:851-856.
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Flurbiprofen 100 mg
Acetaminophen 650 mg + Oxycodone 10 mg
First dose Second doseTime (hours)
* ** **
* p < 0.01
Pre-emptive and Post-Surgery Flurbiprofen and Acetaminophen + Oxycodone
Dionne RA. Amer J Med 1986; 80(suppl 3A):41-49
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Placebo (n=62)
Oxycodone 5 mg (n=63)
Ibuprofen 400 mg (n=186)
Ibuprofen 400 mg/Oxycodone 5 mg (n=186)
Van Dyke T et al. Clin Ther. 2004;26(12):2003-14.
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Hours After Dose
Mea
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Placebo (n=45)
Acetaminophen 1000 mg(n=89)
Naproxen Na 440 mg(n=92)
Kiersch et al, Clin Ther 16:395-404, 1994Oral Surgery
Gordon S M, Dionne RA et al. Anesth Analg 2002;95:1351-1357
Figure 3. Pain intensity in the immediate postoperative period over the first 4 h after surgery, depicted as the sum of pain intensity (upper panel), and at 48 h after surgery
(lower panel), as measured by a 200-mm verbal descriptor scale
Single dose oral ibuprofen for acute postoperative pain in adults.Derry C, Derry S, Moore RA, McQuay HJ.
Conclusions• In postsurgical dental pain studies NSAIDs at optimal doses
are superior in efficacy to single entity opioids and are at least as efficacious as optimal doses of peripheral-narcotic combination drugs.
• In postsurgical dental pain studies NSAIDs have a much more favorable side effect profile than agents that contain an opioid.
• The use of pre-emptive NSAIDs and long-acting local anesthetics appear to greatly delay the onset of post-surgical dental pain and may have benefit beyond the immediate postoperative period.
• NSAIDs should be considered the first line drugs in most cases of postsurgical dental pain.