Study: Patients prescribed opioids report more pain

A recent study at the University of Michigan has found that dental patients who have been prescribed opioids reported their pain was worse than those who were not.

Researchers looked at 325 dental patients who had their teeth pulled, and asked them to rate their pain and satisfaction within six months of the extraction. They then compared the pain and satisfaction rate of those who were and were not prescribed opioids.

Researchers found that half of the study’s patients who had surgical extraction and 39 percent who had routine extraction were prescribed opioids.

“I feel like the most important finding is that patient satisfaction with pain management was no different between the opioid group and non-opioid group, and it didn’t make a difference whether it was surgical or routine extraction,” said study co-author Romesh Nalliah, clinical professor and associate dean for patient services at the U-M School of Dentistry.

More than that, researchers found that those who were prescribed opioids actually reported worse pain, Nalliah said.

Reported in JAMA Network Open, the study also found that patients used only half of their prescriptions, putting themselves and their families at risk of future misuse of opioids.

“The real-world data from this study reinforces the previously published randomized-controlled trials showing opioids are no better than acetaminophen and nonsteroidal anti-inflammatory drugs for pain after dental extraction,” said study co-author Chad Brummett, director of the Division of Pain Research and of Clinical Research in the Department of Anesthesiology at Michigan Medicine, U-M’s academic medical center. Brummett co-directs the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN, which has developed, tested, and shared guidelines for the use of opioids in patients with acute pain from surgery and medical procedures. “These data support the Michigan OPEN prescribing recommendations calling for no opioids for the majority of patients after dental extractions, including wisdom teeth extraction,” he said.

While the American Dental Association has taken a position that dentists should limit opioid prescriptions to no more than a seven-day supply, Nalliah disagrees.

“I think we can almost eliminate opioid prescribing from dental practice. Of course, there are going to be some exceptions, like patients who can’t tolerate nonsteroidal anti-inflammatories,” he said. “I would estimate we can reduce opioid prescribing to about 10 percent of what we currently prescribe as a profession.”

In the United States, dentists make up about 6 percent to 6.5 percent of all opioid prescriptions, the study said. But the study also found that dentists commonly prescribe opioids to minors and that for some patients, dental opioid prescriptions are the first time they are exposed to the drug.