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37
Volume 2 Issue 2
|
S
upporting
Y
our
P
ractice
Opioid analgesic prescribing
for chronic non-cancer
orofacial pain
It is unclear how often Canadian dentists or family
physicians use opioid analgesics for the treatment
of moderate to severe chronic non-cancer orofacial
pain conditions such as temporomandibular
disorders (TMDs) and neuropathies. Dentists, in
particular, may not feel confident prescribing or
monitoring opioid analgesics for these chronic
pain conditions.
There is also little evidence that supports the
use of opioid analgesics for the treatment of
chronic orofacial pain (
Table 1
). Nevertheless,
the use of opioid analgesics for chronic TMDs
pain that has not responded adequately to all
other treatments (i.e., physical therapy, cognitive
and behavioural therapy, NSAIDs such as
ibuprofen or diclofenac, antidepressants such
as nortriptyline or duloxetine, and antiepileptics
such as gabapentin) may be warranted. How
ever, evidence indicates that only a subgroup
of patients will find opioid analgesics effective
over months or years, and of these, 50% will have
adverse effects that will lead many to discontinue
their use.
8, 9
Thus, it is recommended that initiation
of opioid analgesic therapy be done on a trial
basis and re-evaluated frequently (
Table 1
).
Long-term opioid treatment
of chronic nonmalignant
orofacial pain: unproven
efficacy and neglected safety?
The focus group suggested that future
prospective studies should be conducted to
assess management of acute, post-operative
and chronic orofacial pain in Canada. Such
studies should include quantitative and
qualitative measures of pain as well as measures
of psychosocial factors and addiction risk.
7, 10
These studies should include evaluations at
least 6 months after an operation in order to
determine the prevalence of persistent post-
operative pain and to evaluate the efficacy of
sustained use of opioid analgesics to treat
chronic orofacial pain conditions.
a
References
Complete listofreferencesavailableat
jcda.ca/article/e49The views expressed are those of the authors and do not necessarily reflect the opinions
or official policies of the Canadian Dental Association.
*Sourceof infographics:CanadianPainSociety.
Pain inCanada factsheet.
June2014.
[accessed2014Dec8].Available
:http://c.ymcdn.com/sites/www.canadianpainsociety.ca/resource/resmgr/Docs/pain_fact_sheet_en.pdf
The focus group suggested that
future prospective studies should
be conducted to assess management
of acute, post-operative and chronic
orofacial pain in Canada.
1
in
5
Canadian adults
suffer from chronic pain.*
H
Pain accounts for up to
78%
of
visits
to the
emergency department.*
<1%
Less than 1%
of
total CIHR funding and
only 0.25%
of total
funding for health
research goes to
pain research.
(based on 2009 data)
*