37
Volume2 Issue2
|
S
upporting
Y
our
P
ractice
Opioid analgesicprescribing
for chronicnon-cancer
orofacial pain
It isunclear howoftenCanadiandentistsor family
physiciansuseopioidanalgesics for the treatment
ofmoderate to severechronicnon-cancer orofacial
painconditions suchas temporomandibular
disorders (TMDs) andneuropathies. Dentists, in
particular,maynot feel confident prescribingor
monitoringopioidanalgesics for thesechronic
painconditions.
There is also littleevidence that supports the
useof opioidanalgesics for the treatment of
chronicorofacial pain (
Table1
). Nevertheless,
theuseof opioidanalgesics for chronicTMDs
pain that hasnot respondedadequately toall
other treatments (i.e., physical therapy, cognitive
andbehavioural therapy, NSAIDs suchas
ibuprofenor diclofenac, antidepressants such
asnortriptylineor duloxetine, andantiepileptics
suchasgabapentin)maybewarranted. How
ever, evidence indicates that onlya subgroup
of patientswill findopioidanalgesics effective
overmonthsor years, andof these, 50%will have
adverseeffects thatwill leadmany todiscontinue
their use.
8, 9
Thus, it is recommended that initiation
of opioidanalgesic therapybedoneona trial
basis and re-evaluated frequently (
Table1
).
Long-termopioid treatment
of chronicnonmalignant
orofacialpain:unproven
efficacyandneglected safety?
The focusgroup suggested that future
prospective studies shouldbeconducted to
assessmanagement of acute, post-operative
andchronicorofacial pain inCanada. Such
studies should includequantitativeand
qualitativemeasuresof painaswell asmeasures
of psychosocial factors andaddiction risk.
7, 10
These studies should includeevaluations at
least 6months after anoperation inorder to
determine theprevalenceof persistent post-
operativepainand toevaluate theefficacyof
sustaineduseof opioidanalgesics to treat
chronicorofacial painconditions.
a
References
Complete listofreferencesavailableat
Theviewsexpressedare thoseof theauthorsanddonotnecessarily reflect theopinions
orofficial policiesof theCanadianDentalAssociation.
*Sourceof infographics:CanadianPainSociety.Pain inCanada factsheet.June2014.
[accessed2014Dec8].Available:
The focus group suggested that
future prospective studies should
be conducted toassessmanagement
of acute, post-operative and chronic
orofacial pain inCanada.
1
in
5
Canadianadults
suffer from chronicpain.*
H
Painaccounts forup to
78%
of
visits
to the
emergencydepartment.*
<1%
Lessthan1%
of
total CIHR fundingand
only0.25%
of total
funding forhealth
researchgoes to
pain research.
(basedon2009data)
*
