A clinical trial involving more than 1,800 patients found that those given a combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) experienced less pain, better sleep, and higher satisfaction compared with those receiving the opioid hydrocodone with acetaminophen, according to a Rutgers Health study.
Researchers at Rutgers University conducted a randomized trial on patients undergoing surgical removal of impacted wisdom teeth to compare opioid and non-opioid pain relief.
“We think this is a landmark study,” said Cecile Feldman, dean of Rutgers School of Dental Medicine and lead author of the study. “The results actually came in even stronger than we thought they would.”
Wisdom tooth extraction is a common procedure that typically causes moderate to severe pain. Dental procedures such as these are often the first exposure to opioid medications for many young adults. Dentists rank among the leading prescribers of opioids, having written more than 8.9 million opioid prescriptions in the United States in 2022. Opioid usage is also problematic in Canada, where Canadians are the second-largest per-capita users of prescription opioids globally, consuming more than 34,000 daily doses (equivalent to 100 mg of morphine) per million people between 2013 and 2015. In comparison, the United Kingdom reported 12,000 daily doses per million people, Sweden reported 10,000, and Japan only 1,200.
The study, published in The Journal of the American Dental Association, showed that the non-opioid combination provided superior pain relief during the peak-pain period in the two days following surgery. Patients taking the non-opioid medications also reported better sleep quality on the first night and less interference with daily activities throughout recovery.
“We feel pretty confident in saying that opioids should not be prescribed routinely and that if dentists prescribe the non-opioid combination, their patients are going to be a lot better off,” Feldman concluded.
Hope to see change
The findings align with recent recommendations from the American Dental Association, which advises against opioids as first-line pain treatment. Feldman said she hopes the results will lead to changes in prescribing practices.
“For a while, we’ve been talking about not needing to prescribe opioids,” Feldman said. “This study’s results are such that there is no reason to be prescribing opioids unless you’ve got those special situations, like medical conditions preventing the use of ibuprofen or acetaminophen.”
The researchers hope to expand their work to study other dental procedures, additional pain scenarios, and potential alternatives such as cannabinoids for managing dental pain.
The Opioid Analgesic Reduction Study was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research.
