scholarly journals The Opioid Analgesic Reduction Study (OARS): A Comparison of Opioid vs. Non-Opioid Combination Analgesics for Management of Post-Surgical Pain Study Protocol for a Double-Blind Randomized Multi-Center Clinical Trial

2021 ◽  
Author(s):  
Cecile A. Feldman ◽  
Janine Fredericks-Younger ◽  
Shou-En Lu ◽  
Paul J. Desjardins ◽  
Hans Malmstrom ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Pain Management ◽  
Opioid Analgesic ◽  
Third Molar ◽  
The United States ◽  
Double Blind ◽  
Post Operative Pain ◽  
Decision Making Tool ◽  
Molar Extraction

Abstract Background: Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription a patient’s risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the United States, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient’s risk for addiction.Methods: A double blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision making tool, pain management, extraction difficulty and number of tablets taken is being collected enabling an experimental decision making tool to be developed. Discussion: The proposed methods address the short comings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 hours. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, either related to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management.Trial registration: ClinicalTrials.gov NCT04452344. Registered on June 20, 2020

scholarly journals Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period

2014 ◽  
pp. e157-e162 ◽  
Author(s):  
MC. de la Barrera-Nunez ◽  
RM. Yanez-Vico ◽  
A. Batista-Cruzado ◽  
JM. Heurtebise-Saavedra ◽  
R. Castillo-de Oyague ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Period ◽  
Third Molar ◽  
Double Blind ◽  
The Third ◽  
Third Molar Extraction ◽  
Double Blind Clinical Trial ◽  
Molar Extraction

Peripheral morphine reduces acute pain in inflamed tissue after third molar extraction: A double-blind, randomized, active-controlled clinical trial

2016 ◽  
Vol 11 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Ethem Akural ◽  
Voitto Järvimäki ◽  
Keijo Alaniska ◽  
Oikarinen Kyösti ◽  
Seppo Alahuhta
Keyword(s):  
Clinical Trial ◽  
Acute Pain ◽  
Third Molar ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Third Molar Extraction ◽  
Inflamed Tissue ◽  
Molar Extraction

Graphical Abstract

scholarly journals Shared Decision-Making for Pain Management After Third Molar Extractions in Adolescents: A Qualitative Study

2021 ◽  
Author(s):  
Shannon Mitchell ◽  
Anjali Truitt ◽  
Lauryn Davin ◽  
D. Brad Rindal
Keyword(s):  
Decision Making ◽  
Pain Management ◽  
Shared Decision Making ◽  
Third Molar ◽  
Administrative Databases ◽  
Shared Decision ◽  
Opioid Prescription ◽  
Over The Counter ◽  
Adolescent Patients ◽  
Opioid Medications

Abstract Background: Understanding how adolescent patients and their parents make decisions about pain management after complex dental procedures could help reduce the use of opioid medications in this population. This study explored how adolescent patients and their parents make decisions about pain management after third molar extractions.Methods: Participants were identified from administrative databases based on age (15-17 years) and a dental extraction performed in the last 8 days. Structured interviews were conducted by phone, with interview guides tailored separately to patients and parents. De-identified interview transcripts were analyzed using qualitative analysis software using a directed content analysis approach.Results: A total of 15 patient/parent dyads were interviewed. There was high concordance in terms of shared decision-making and pain management views in this dyadic sample. In addition to conversations with their dentist, most patients and their parents discussed pain management plans that included non-medication options, over-the-counter medications, and opioid medications to be taken as needed. All participants reported that the adolescent received an opioid prescription for post-extraction pain management but most only took it the day of the extraction and up to 2 days following, usually based on the patient’s reported pain levels and perceptions of over-the-counter medication adequacy. Participants said they did not receive guidance from their provider concerning disposal of unused opioid medications. Conclusions: Shared decision-making concerning pain management was common for adolescents and their parents following third molar extractions. Providers may have an opportunity to reduce the number of opioids prescribed, since respondents reported little to no use of opioids that they were prescribed. Providers should educate patients and their parents about safe disposal of opioids to mitigate the potential for diversion.Trial registration: not applicable

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

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