In response to the nationwide opioid epidemic, the American Association of Oral and Maxillofacial Surgeons (AAOMS) has released prescription recommendations that urge ibuprofen rather than opioids to be used as a first-line therapy to manage a patient’s acute and post-surgical pain.
Recognizing the value and importance of the doctor-patient relationship, the AAOMS white paper “Opioid Prescribing: Acute and Postoperative Pain Management” stresses that practitioners should be allowed to make individualized pain management decisions for their patients, including drug types, dosages, and treatment durations.
If opioids are considered, the AAOMS recommends beginning with the lowest possible effective dose for the shortest duration possible. Long-acting or extended-release opioids should be avoided as a starting treatment, the AAOMS advises. As an alternative, the AAOMS reports, ibuprofen and acetaminophen taken simultaneously can rival opioids in their analgesic effect.
“Patient safety is the top priority of the American Association of Oral and Maxillofacial Surgeons,” said AAOMS president Douglas W. Fain, DDS, MD. “Therefore, AAOMS has taken a leadership role in combatting the opioid epidemic affecting this country. It is crucial for our doctors to responsibly prescribe based on individual patient needs and to use non-opioids when appropriate.”
When using opioids to manage pain, doctors are advised to prescribe them safely and expertly, use their state’s prescription drug-monitoring program, and inform patients and their families about their risks and safe use, storage, and disposal. Doctors also should remain aware of the most recent public health trends, the AAOMS says, including potential alternatives to opioids.
The white paper’s recommendations are the work of the Special Committee on Opioid Prescribing appointed by the AAOMS Board of Trustees this spring. They are intended to provide direction and serve as a supportive resource. The recommendations include:
- Non-steroidal anti-inflammatory drugs (NSAIDs, generically known as ibuprofen) should be prescribed as a first-line pain relief therapy unless they are harmful to the patient. In that case, acetaminophen should be prescribed.
- Dosage levels and times of administration of ibuprofen and acetaminophen taken simultaneously should be documented to prevent overdosage.
- Patients should be informed not to exceed 3,200 milligrams of ibuprofen per day. The maximum recommended daily dose of acetaminophen is 3,000 milligrams.
- Doctors should access the state’s prescription drug-monitoring program or other resources if they suspect patient drug misuse.
- Doctors should document all instructions for each patient’s pain relief and prescriptions.
- Doctors should document reasoning for not following these recommendations or those required by state laws or institutions.
- Corticosteroids should be considered during surgery to limit swelling and reduce post-surgical discomfort after wisdom teeth removal.
- Long-acting local anesthetics should be considered to postpone the onset and severity of post-surgical pain.
According to a 2017 AAOMS survey of its fellows and members, nearly 50% of respondents have decreased the number of narcotics they have prescribed for wisdom teeth extraction cases in the last 2 years. Also, nearly 72% of respondents said they would refill a narcotic pain prescription only if they see the patient first.