Non-Opioid Pain Management: An Evidence-Based Approach

Over-prescription of opioids after dental and other types of surgery fueled the opioid epidemic in the United States, leading to 49,860 overdose deaths in 2019 alone, according to the Centers for Disease Control and Prevention (CDC). In dentistry, nearly 1 in 3 opioids (29.6%) were prescribed for pain that was expected to be mild and 29.3% of prescriptions exceeded the recommended dose, according to an analysis of 542,958 U.S. dental visits between 2011 and 2015 within the Truven Health MarketScan Research Databases.2 More than half of the visits (53%) were for oral and maxillofacial surgery.

Evidence-Based Pain Management

Using an evidence-based, multi-modal approach, The Center For Oral Surgery & Dental Implants (COSDI) cares for most surgical patients with non-opioid pain management. “We now have many non-opioid alternatives for pain management both during and after surgical procedures, and patients and families of patients are happy to hear that they will not be at risk of opioid habituation” says Rosie Noordhoek, DDS, an oral surgeon at COSDI.

For pain management, Dr. Noordhoek and our other oral surgeons follow the evidence-based guidelines, best practices and recommendations of the:

  • American Dental Association (ADA)
  • Centers for Disease Control and Prevention (CDC)
  • Michigan Opioid Prescribing Engagement Network
  • Michigan Prescription Drug & Opioid Abuse Commission.

They also comply with Michigan state regulations and complete continuing education in prescribing opioids and other controlled substances.

Long-Lasting Pain Control

The evidence-based, multi-modal approach at COSDI starts with planning for post-operative pain management. Our oral surgeons screen patients for risky substance-use behaviors and provide counseling about the benefits and drawbacks of opioids.

Techniques for long-lasting pain control used during surgery include EXPAREL, Sockit Gel and Ketorolac. EXPAREL (bupivacaine liposome injectable suspension) is a single-dose, local anesthetic infiltration that provides significant pain control for the first few post-operative days while reducing opioid use.3 4 5 Sockit Gel is an all-natural, FDA-approved treatment that accelerates healing of oral wounds. The NSAID Ketorolac is administered intravenously or intramuscularly and replaces the first few doses of oral NSAIDS.

Post-surgery, ibuprofen and/or acetaminophen are the first-line pain-management treatments for our patients. Effective non-medication measures include rest, heat, ice, stretching, good hygiene, hydration and mindfulness practices such as meditation.

Low-Dose, Short-Term Opioids

For breakthrough or severe pain, our oral surgeons prescribe the lowest effective opioid dose for no more than seven days, as per the ADA and CDC recommendations and guidelines. They educate patients on how to taper opioids as their pain resolves and how to store, monitor and dispose of unused medication at home.

COSDI oral surgeons electronically report prescription of opioids on the Michigan Automated Prescription System, the state’s prescription drug monitoring program.

For more information about non-opioid pain management at the Center For Oral Surgery & Dental Implants, call 616-361-7327.


References

1 Suda KD, Zhou J, Woman SA, et al. Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015. Am J Preventive Med. 2020; 58(4): 473-486. Accessed 1/10/22.

2 Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2018;33(1):90-96. doi:10.1016/j.arth.2017.07.024.

3 Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54(12):1552-1559.

4 Data on File. 2857. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; June 2017.