Postoperative Pain Responses in Dental Patients on Chronic Opioid Therapy

Abstract

It is estimated that 5 to 8 million Americans use opioids daily for the management of chronic pain. Yet, opioid therapy for chronic pain is not an evidence-based intervention, and it is increasingly apparent that outcomes are poorer for patients taking opioids (pain severity, functionality, quality of life) (1). A theorized explanation for these poor outcomes is the phenomenon of opioid-induced hyperalgesia (OIH) (2), defined as increased sensitivity to pain related to chronic opioid use, and which may interfere with desired pain relief in the chronic pain patient. This study was designed to compare pain responses and analgesic need in a sample of dental patients on chronic opioid therapy vs. not on opioid therapy, the first study of its kind. A total of 40 adult dental surgical patients are being enrolled in the study, 20 of whom are on opioid therapy for chronic pain, all undergoing a dental surgical procedure with a similar expected trauma rating, and standardized postoperative non-opioid pain management. Those in the opioid group are taking a regular daily dose of opioids ≥ 50mg morphine equivalents/day for ≥ 3 months and those in the control group have not taken an opioid medication within 3 months. Exclusion criteria include active substance use disorder; severe psychiatric disorder; neurological or psychiatric illness that would affect pain responses; history of GI ulcers; NSAID allergy; poor liver or kidney function; or pregnancy. Prior to the surgical procedure, pain perception is measured using 2 standardized experimental pain assays (cold-pressor testing; quantitative sensory testing) to detect OIH. To determine how OIH may affect postoperative pain responses, patient-reported pain severity and documentation of all analgesic consumption for the first 72 hours are collected. If preoperative opioid use is found to result in increased postoperative pain severity, clinical implications may include anticipation of increased analgesic need or preoperative opioid taper.