This study compares the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction. We searched Medline, EMBASE, CENTRAL, and US Clinical Trials registry on November 21, 2020. We included randomized clinical trials (RCTs) of participants undergoing dental extractions comparing 10 interventions, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations to placebo. After duplicate screening and data abstraction, we conducted a frequentist network meta-analysis for each outcome at 6 h (i.e., pain relief, total pain relief [TOTPAR], summed pain intensity difference [SPID], global efficacy rating, rescue analgesia, and adverse effects). We assessed the risk of bias using a modified Cochrane RoB 2.0 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We implemented the analyses in RStudio version 3.5.3 and classified interventions from most to least beneficial or harmful. We included 82 RCTs. Fifty-six RCTs enrolling 9,095 participants found moderate- and high-certainty evidence that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg (mean difference compared to placebo [MDp], 1.68; 95% confidence interval [CI], 1.06-2.31), acetaminophen 650 mg plus oxycodone 10 mg (MDp, 1.19; 95% CI, 0.85-1.54), ibuprofen 400 mg (MDp, 1.31; 95% CI, 1.17-1.45), and naproxen 400-440 mg (MDp, 1.44; 95% CI, 1.07-1.80) were most effective for pain relief on a 0 to 4 scale. Oxycodone 5 mg, codeine 60 mg, and tramadol 37.5 mg plus acetaminophen 325 mg were no better than placebo. The results for TOTPAR, SPID, global efficacy rating, and rescue analgesia were similar. Based on low- and very low-certainty evidence, most interventions were classified as no more harmful than placebo for most adverse effects. Based on moderate- and high-certainty evidence, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.
The naturally occurring cannabis plant has played an established role in pain management throughout recorded history. However, in recent years, both natural and synthetic cannabis-based products for medicinal use (CBPM) have gained increasing worldwide attention due to growing evidence supporting their use in alleviating chronic inflammatory and neuropathic pain associated with an array of conditions. In view of these products' growing popularity in both the medical and commercial fields, we carried out a systematic review to ascertain the effects of cannabis and its synthetically derived products on orofacial pain and inflammation. The application of topical dermal cannabidiol formulation has shown positive findings such as reducing pain and improving muscle function in patients suffering from myofascial pain. Conversely, two orally-administered synthetic cannabinoid receptor agonists (AZD1940 and GW842166) failed to demonstrate significant analgesic effects following surgical third molar removal. There is a paucity of literature pertaining to the effects of cannabis-based products in the orofacial region; however, there is a wealth of high-quality evidence supporting their use for treating chronic nociceptive and neuropathic pain conditions in other areas. Further research is warranted to explore and substantiate the therapeutic role of CBPMs in the context of orofacial pain and inflammation. As evidence supporting their use expands, healthcare professionals should pay close attention to outcomes and changes to legislation that may impact and potentially benefit their patients.
Objective The purpose of our study was to perform a systematic review and meta-analysis of randomized, blinded, placebo-controlled studies that, following third-molar extraction, utilized either a combination of acetaminophen (600 mg) with codeine (60 mg) or ibuprofen (400 mg) for pain management. Design We searched PubMed, and the trial registry ClinicalTrials.gov databases with the keywords "molar or molars," "tooth or teeth," "extraction," and "pain." Selected studies were: (1) randomized, blinded, placebo controlled, (2) utilized either a single-dose combination acetaminophen (600 mg) with codeine (60 mg) (A/C) or ibuprofen, and (3) recorded standardized pain relief (PR) at 6 hours, or summed total pain relief over 6 hours (TOTPAR6). Of the 2,949 articles that were identified, 79 were retrieved for full-text analysis, and 20 of these studies met our inclusion criteria. Results For A/C, the weighted, standardized mean difference (SMD) for TOTPAR6 was 0.796 (95% confidence interval [CI], 0.597–0.995), P < .001, and for PR at 6 hours, the SMD was 0.0186 (0.007 to 0.378; P = .059), whereas for ibuprofen the SMD for TOTPAR6 was 3.009 (1.283 to 4.735; P = .001), and for PR at 6 hours, the SMD was 0.854 (95% CI, 0.712–0.996; P < .001). A SMD of 0.8 or larger is indicative of a large effect. Conclusions Our data indicate that single dose of ibuprofen (400 mg) is an effective pain reducer for post third molar extraction pain.
The purpose of this systematic review was to determine the analgesic efficacy and adverse effects of ibuprofen in comparison with other traditional non-opioid analgesics after third molar surgery. A total of 17 full texts were identified in PubMed and assessed using the Cochrane Collabo-ration’s risk of bias tool by two independent researchers. The sum of pain intensity differences, total pain relief, the overall evaluation, the number of patients requiring rescue analgesics, and adverse effects were collected. Data were analyzed using the Review Manager Software 5.3. for Windows. A total of 15 articles met the criteria. The qualitative and quantitative analysis showed that ibuprofen is more effective to relieve post-operative dental pain than acetaminophen, meclofenamate, aceclofenac, bromfenac, and aspirin. Moreover, ibuprofen and traditional non-steroidal anti-inflammatory drugs have a similar safety profile. In conclusion, ibuprofen 400 mg appears to have good analgesic efficacy and a safety profile similar to other traditional non-steroidal anti-inflammatory drugs after third molar surgery.
Cannabinoids, cannabis, and cannabis-based medicines (CBMs) are increasingly used to manage pain, with limited understanding of their efficacy and safety. We summarised efficacy and adverse events (AEs) of these types of drugs for treating pain using randomised controlled trials: in people of any age, with any type of pain, and for any treatment duration. Primary outcomes were 30% and 50% reduction in pain intensity, and AEs. We assessed risk of bias of included studies, and the overall quality of evidence using GRADE. Studies of < 7 and > 7 days treatment duration were analysed separately. We included 36 studies (7217 participants) delivering cannabinoids (8 studies), cannabis (6 studies), and CBM (22 studies); all had high and/or uncertain risk of bias. Evidence of benefit was found for cannabis < 7 days (risk difference 0.33, 95% confidence interval 0.20-0.46; 2 trials, 231 patients, very low-quality evidence) and nabiximols > 7 days (risk difference 0.06, 95% confidence interval 0.01-0.12; 6 trials, 1484 patients, very low-quality evidence). No other beneficial effects were found for other types of cannabinoids, cannabis, or CBM in our primary analyses; 81% of subgroup analyses were negative. Cannabis, nabiximols, and delta-9-tetrahydrocannabinol had more AEs than control. Studies in this field have unclear or high risk of bias, and outcomes had GRADE rating of low- or very low-quality evidence. We have little confidence in the estimates of effect. The evidence neither supports nor refutes claims of efficacy and safety for cannabinoids, cannabis, or CBM in the management of pain. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Aim: This study aims to perform a literature review that reports on the use of opioid analgesics and their efficacy after extracting third molars, comparing them with other types of drugs. Methods: The search of articles in the PubMed database was carried out from 2006 to 2016, resulting in a total of 131 articles. Of these, 122 articles that did not report the use of opioids that were not from the Dentistry area, or that did not report the use of opioids after the extraction of third molars, were excluded. Literature reviews or non-comparative articles were also excluded. Thus, 9 articles were considered and incorporated into the review. Results: This review identified some clinical trials comparing the use of opioid analgesics with other drug options. From the trials comparing opioid analgesics with other NSAIDs (N = 3), with no drug combinations, NSAIDs proved to be more effective or, in the case of preemptive analgesia, had the same effect. Studies comparing the association of opioid analgesics with NSAIDs (N = 4) have shown that the association is more beneficial than the use of opioids alone. A single study that tested the association between opioids and corticosteroids has shown that this association is more effective than the association between opioids and NSAIDs. One study, which tested the association between opioids and paracetamol with NSAIDs concluded that the efficacy was similar between groups. Conclusion: Opioid analgesics are generally less effective than NSAIDs in controlling pain after the extraction of third molars. Its association with NSAIDs is recommended in some clinical situations. The use of opioids as the first choice seems to be restricted to patients with a contraindication to the use of NSAIDs.(AU)
Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3-69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.
Esta revisión es una actualización de "Dosis oral de ketoprofen y dexketoprofen para el dolor postoperatorio agudo en adultos" actualizado por última vez en la edición 4, 2009. El ketoprofeno es un fármaco antiinflamatorio no esteroideo no selectivo (AINE) utilizado para tratar la enfermedad aguda y crónica Dolorosas. El dexketoprofeno es el enantiómero (S), que se cree que confiere analgesia. Teóricamente, se espera que el dexketoprofeno proporcione analgesia equivalente al ketoprofeno a la mitad de la dosis, con la consiguiente reducción de los efectos adversos gastrointestinales. Esta revisión forma parte de una serie de analgésicos orales para el dolor postoperatorio agudo. Las revisiones individuales se han reunido en dos reseñas para proporcionar información sobre la eficacia relativa y el daño de las diferentes intervenciones. Evaluar la eficacia y la seguridad de la dosis única oral de ketoprofeno y dexketoprofeno oral en comparación con el placebo para el dolor postoperatorio agudo, utilizando métodos que permiten la comparación con otros analgésicos evaluados de la misma manera y los criterios de eficacia recomendados por un estudio a fondo en El nivel individual del paciente. MÉTODOS DE BÚSQUEDA: Para esta actualización, se realizaron búsquedas en el Registro Central Cochrane de Ensayos Controlados (CENTRAL), MEDLINE y Embase del 2009 al 28 de marzo de 2017. También se realizaron búsquedas en las listas de referencias de estudios y revisiones recuperados y dos registros de ensayos clínicos en línea. Ensayos aleatorios, doble ciego, controlados con placebo de ketoprofen o dexketoprofen administrado por vía oral de dosis única en adultos con dolor postoperatorio agudo moderado a grave. Dos autores revisaron de forma independiente los estudios para su inclusión en la revisión, examinaron los problemas de calidad del estudio y los sesgos potenciales, y extrajeron los datos. Para los resultados dicotómicos, se calculó el cociente de riesgo (RR) y el número necesario para tratar un resultado beneficioso adicional (NNT) o resultado perjudicial (NNH) con intervalos de confianza (IC) del 95% para ketoprofeno y dexketoprofeno, en comparación con el placebo. Datos suficientes. Se recopiló información sobre el número de participantes con al menos el 50% del alivio máximo posible del dolor durante seis horas, el tiempo medio de uso de la medicación de rescate y la proporción de participantes que necesitaban medicación de rescate. También recopilamos información sobre eventos adversos y retiros. Evaluamos la calidad de la evidencia usando GRADE, y creamos tablas de "Resumen de hallazgos". PRINCIPALES RESULTADOS: Esta revisión actualizada incluyó 24 estudios; Seis estudios adicionales añadieron 1001 participantes que participaron en comparaciones de cetoprofeno o dexketoprofeno y placebo, con un aumento del 12% en los participantes que tomaron ketoprofeno y un aumento del 65% para dexketoprofeno. La mayoría de los participantes (70%) eran mujeres. Los estudios dentales típicamente involucraron participantes jóvenes (edad media de 20 a 30 años); Otros tipos de cirugía involucraron participantes mayores (edad media de 37 a 68 años). En general, se juzgó que los estudios de alto riesgo de sesgo sólo para el tamaño pequeño, lo que puede conducir a una sobreestimación del beneficio. Las dosis de ketoprofeno oscilaron entre 6,5 mg y 150 mg. La proporción de participantes que lograron al menos un 50% de alivio del dolor durante seis horas con la dosis oral habitual de ketoprofeno de 50 mg fue del 57%, comparado con el 23% con placebo, dando un NNT de 2,9 (IC del 95%: 2,4 a 3,7) , IC del 95%: 2,0 a 3,1, 594 participantes, 8 estudios, evidencia de alta calidad). La eficacia fue significativamente mejor en los estudios dentales (NNT 1.8) que en otras cirugías (NNT 4.2). La proporción de participantes que usaron medicación de rescate en seis horas fue menor con ketoprofeno (32%) que con placebo (75%), dando un número necesario para tratar el uso de medicación de rescate (NNTp) de 2,3 (IC del 95% 1,8 a 3,1 ); 263 participantes; 4 estudios; Evidencia de alta calidad). El tiempo mediano hasta las estimaciones de remediación fue mal informado. Los informes de cualquier evento adverso fueron similares con ketoprofeno (18%) y placebo (11%) (RR 1,6, IC del 95%: 0,98 a 2,8, 342 participantes, 5 estudios, evidencia de alta calidad). Ningún estudio informó ningún evento adverso grave (pruebas de muy baja calidad). Las dosis de dexketoprofeno variaron entre 5 mg y 100 mg. La proporción de participantes que lograron al menos 50% de alivio del dolor durante seis horas con la dosis oral habitual de dexketoprofeno de 20 mg o 25 mg fue del 52%, comparado con el 27% con placebo, con un NNT de 4,1 (IC del 95%: 3,3 a 5,2) (RR 2,0, IC del 95%: 1,6 a 2,2, 1177 participantes, 8 estudios, evidencia de alta calidad). La eficacia fue significativamente mejor en los estudios dentales (NNT 2.7) que en otras cirugías (NNT 5.7). La proporción de participantes que usaron medicación de rescate en seis horas fue menor con ketoprofeno (47%) que con placebo (69%), dando un NNTp de 4,7 (IC del 95%: 3,3 a 8,0); 445 participantes; 5 estudios; Evidencia de alta calidad). El tiempo mediano hasta las estimaciones de remediación fue mal informado. Los informes de cualquier evento adverso fueron similares con dexketoprofeno (14%) y placebo (10%) (RR 1,4, IC del 95%: 0,89 a 2,2, 536 participantes, 6 estudios, evidencia de alta calidad). Ningún estudio informó eventos adversos graves (evidencia de muy baja calidad). El ketoprofeno a dosis de 25 mg a 100 mg es un analgésico eficaz en el dolor postoperatorio agudo moderado a severo con un NNT para al menos un 50% de alivio del dolor de 2,9 con una dosis de 50 mg. Esto es similar al de los NSAIDs de uso común tales como ibuprofeno (NNT 2.5 para la dosis de 400 mg) y diclofenac (NNT 2.7 para la dosis de 50 mg). El dexketoprofeno también es eficaz con un NNT de 4,1 en el intervalo de dosis de 10 mg a 25 mg. La eficacia diferencial entre la cirugía dental y otros tipos de cirugía vistos para ambos fármacos es inusual. Ambos fármacos fueron bien tolerados en dosis únicas.
Los medicamentos canabinérgicos se han postulado para demostrar la eficacia en el tratamiento del dolor. El objetivo de esta revisión sistemática fue evaluar la eficacia analgésica y los efectos adversos de los cannabinoides cuando se utilizan para el tratamiento del dolor agudo. MÉTODOS: Se realizó una revisión sistemática en las bases de datos MEDLINE, EMBASE y CENTRAL y en la Plataforma de Registro de Ensayos Clínicos de la Organización Mundial de la Salud para ensayos controlados aleatorios humanos que evaluaron la eficacia analgésica de los cannabinoides en comparación con placebo o comparadores activos. Los resultados informados para la eficacia analgésica y los efectos adversos en los estudios incluidos se analizaron cualitativamente. Resultados Se incluyeron siete estudios, incluidos 611 pacientes, en la revisión sistemática. En cinco estudios se encontró que los cannabinoides proporcionaban analgesia equivalente a placebo, en un estudio la analgesia proporcionada por los cannabinoides fue superior al placebo, y en un estudio los canabinoides proporcionaron analgesia inferior a la proporcionada por el placebo. No se observó efecto analgésico sinérgico o aditivo cuando se usaron cannabinoides en combinación con opioides. En cinco de los siete estudios, ciertos efectos adversos fueron más frecuentes con el tratamiento con cannabinoides que con placebo o comparador activo. CONCLUSIÓN: Sobre la base de la evidencia de ensayos controlados aleatorios disponibles, los cannabinoides no tienen ningún papel en el tratamiento del dolor agudo.
This study compares the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction. We searched Medline, EMBASE, CENTRAL, and US Clinical Trials registry on November 21, 2020. We included randomized clinical trials (RCTs) of participants undergoing dental extractions comparing 10 interventions, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations to placebo. After duplicate screening and data abstraction, we conducted a frequentist network meta-analysis for each outcome at 6 h (i.e., pain relief, total pain relief [TOTPAR], summed pain intensity difference [SPID], global efficacy rating, rescue analgesia, and adverse effects). We assessed the risk of bias using a modified Cochrane RoB 2.0 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We implemented the analyses in RStudio version 3.5.3 and classified interventions from most to least beneficial or harmful. We included 82 RCTs. Fifty-six RCTs enrolling 9,095 participants found moderate- and high-certainty evidence that ibuprofen 200 to 400 mg plus acetaminophen 500 to 1,000 mg (mean difference compared to placebo [MDp], 1.68; 95% confidence interval [CI], 1.06-2.31), acetaminophen 650 mg plus oxycodone 10 mg (MDp, 1.19; 95% CI, 0.85-1.54), ibuprofen 400 mg (MDp, 1.31; 95% CI, 1.17-1.45), and naproxen 400-440 mg (MDp, 1.44; 95% CI, 1.07-1.80) were most effective for pain relief on a 0 to 4 scale. Oxycodone 5 mg, codeine 60 mg, and tramadol 37.5 mg plus acetaminophen 325 mg were no better than placebo. The results for TOTPAR, SPID, global efficacy rating, and rescue analgesia were similar. Based on low- and very low-certainty evidence, most interventions were classified as no more harmful than placebo for most adverse effects. Based on moderate- and high-certainty evidence, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.
