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Dental school establishes novel opioid-free pain management guidelines

By Dental Tribune International
November 21, 2019

PITTSBURGH, U.S.: Doctors continue to routinely prescribe opioid pain relievers for dental procedures. However, current evidence suggests that alternative, nonopioid medications typically work as well or even better for managing pain after dental treatment and do not cause side effects such as nausea, vomiting and constipation or have the potential for misuse. To help fight the opioid epidemic, the University of Pittsburgh School of Dental Medicine (Pitt Dental Medicine) has become the first dental school in the nation to put in place opioid-free pain management guidelines for a wide range of procedures performed in its clinics.

“It’s not a cookbook approach to how to take care of patients,” said Prof. Bernard J. Costello, dean of the school. “This allows clinicians to make good choices based on what they know of the biology of the patient and the patient’s concerns.”

The new guidelines advocate that clinicians should avoid prescribing opioid pain medication. If a patient cannot tolerate opioid alternatives or requires additional pain relief, clinicians should only offer opioids with the lowest potency possible and instruct the patient to take the medication no more than three times a day. Moreover, clinicians should check the patient’s details on the Pennsylvania Prescription Drug Monitoring Program database. Additionally, if a patient is already taking opioids for chronic pain management or for a substance use disorder, an alternative plan should be considered in consultation with a pain management clinician before additional opioids are prescribed.

According to the school, opioid mortality rates are increasingly high in the Appalachian corridor, which includes Western Pennsylvania. Opioid misuse and addiction may also present a great economic burden, as treatment costs approach $90,000 (€81,000) per hospitalization. However, in the Appalachian region, there are now deliberate strategies in place focusing on minimizing dental pain after treatment and eliminating the need for opioid pain relievers.

“Pitt Dental Medicine is leading the way with the adoption of this new protocol by teaching our students and residents the best way to manage pain effectively without the unnecessary risk of opioid dependence,” Costello stated. “When these trainees move on to other practices, they’ll take these opioid-free guidelines with them.”

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