Ibuprofen Superior to Acetaminophen Plus Codeine for Pain Relief After Molar Extraction

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NSAIDs may be as effective as opioids in the management of acute pain after dental extraction.
NSAIDs may be as effective as opioids in the management of acute pain after dental extraction.

The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor's staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.

LAS VEGAS — A single 400 mg dose of ibuprofen was superior to 600 mg acetaminophen plus 60 mg codeine for reducing pain at 6 hours after a third molar extraction, according to a study presented during the 2018 PAINWeek conference, held September 4-8.

“In most cases of third molar extraction, a standard dose of ibuprofen produced superior pain relief with fewer side effects than a similar dose of an opioid pain reliever,” study investigator Kevin Rowland, PhD, section head of physiology, department of applied dental medicine, School of Dental Medicine, Southern Illinois University in Carbondale, told Clinical Pain Advisor. “Third molar extractions are often a person's first exposure to an opioid and often at particularly vulnerable ages during adolescence. The data we collected from existing studies are pointing clinicians to an over-the-counter treatment option for acute dental pain especially for young, healthy individuals which may delay or all together prevent exposure to opioids.”

In a systematic review of the literature published between 1955 and 2018, the researchers examined randomized double-blind placebo-controlled studies that assessed pain after third molar extraction. A 5-point “Pain Relief Scale” was used to assess patient-reported analgesic drug efficacy, with 0 representing “no relief” and 4 representing “complete” pain relief. For the purposes of their analysis, study investigators compared pain relief scores of patients treated with single 400 mg doses of either ibuprofen, acetaminophen with codeine (600 mg + 60 mg), or placebo following dental extraction.

Pain relief scores at 6 hours following surgery were 0.72±0.25, 1.2± 0.35, and 2.3±0.58 for placebo, acetaminophen plus codeine, and ibuprofen, respectively. Compared with placebo, both ibuprofen and acetaminophen with codeine were significantly more effective for inducing 6-hour post-surgical pain relief (P <.05). A comparative analysis between active therapies showed that ibuprofen resulted in significantly higher pain relief scores compared with acetaminophen with codeine (P <.0001).

“We found that although the most commonly prescribed opioid in dentistry is acetaminophen with hydrocodone there are very few pain studies that evaluate its effectiveness on relieving pain in the dental extraction model,” Dr. Rowland explained. “From what has been published, it appears as though ibuprofen is superior to opioids when used in dentistry and poses fewer risks and side effects. If there are other non-opioid analgesics that can achieve the same (or greater) pain relief with fewer adverse events, then why not use them?”

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Reference

Watson H, Rowland K. Pain relief is greater with ibuprofen compared to acetaminophen with codeine: a systematic evaluation of studies using the dental extraction model. Presented at: PAINWeek 2018, September 4-8, 2018, Las Vegas, Nevada. Abstract 27.

For more coverage of PAINWeek 2018, click here.

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