A study published by University of Michigan researchers found that opioid-using patients reported higher pain compared to non-opioid users after surgical or routine extraction procedures. In the study, opioid users left roughly 50 percent of prescribed opioid pills unused and patient satisfaction with pain management was no different between opioid and non-opioid users.
The research project built off a previous big-data study from 2018. Romesh Nalliah, associate dean for Patient Services, was a co-author on both studies. He said the results of the initial study inspired his team to delve deeper into the effects of opioid consumption after dental procedures.
“Big data studies give you a good indication of trends, but of course, it doesn’t have the detail of talking to patients,” Nalliah said. “That’s why we wanted to do this follow up study — to actually talk to the patients and actually understand the people behind the data and basically get a higher level of information from these folks.”
The study consisted of a subject pool of 329 patients, where 47.1 percent were patients of surgical extraction and the others underwent routine extractions. Surgical extractions are under-the-gum surgeries whereas simple tooth extractions are performed on teeth easily seen in the mouth. 51.6 percent and 39.1 percent of patients used opioids after their surgical extraction and routine extraction procedures, respectively.
Nalliah said pinpointing the dose of opioids to prescribe can be tricky, especially because pain is subjective.
“It’s a very difficult environment, so it’s not surprising that dentists and other professions get it wrong,” Nalliah said. “Over the years, when we get it wrong, we tend to err on the side of caution and prescribe more. But now, in this crisis, we’re starting to realize, number one, there are alternatives that could be equally as good, and number two, the risks with opioids are severe.”
Dentistry student Shernel Thomas, a co-author of the study, assisted with data collection by interviewing many of the patients. Thomas said when contacting the patients, she was surprised how many patients were aware of the opioid crisis. According to the National Institute of Drug Abuse, 128 people die in the United States every day from opioid overdose.
“They had long stories about either them having personal experiences with opioids or knowing someone who had,” Thomas said. “(They were) actually happy that they either got less opioids and were trying to take less. There were actually few patients that went, ‘Oh I really wished they had given me more opioids,’ so that was actually really surprising to me that (opioid dosage) didn’t seem to matter as much to the patients, especially if they had a doctor tell them about the type of pain they were going to feel and (managed their) expectations surrounding pain.”
University alum Kenny Sloss, another co-author on the study, was a clinical subjects coordinator with Michigan Opioid Prescribing Engagement Network at the time the study was conducted. Sloss said he became involved with this type of research when he first joined Michigan OPEN as a research assistant, which allowed him to see the opioid crisis from a different perspective.
“When I first began, I came in as a research assistant, and I had little knowledge about the doctor side of the epidemic,” Sloss said. “I had seen personal friends and even people in my own community that had overdosed from opioid abuse … (The researchers) explained how the results that I was seeing in my own community transferred to the other side of things in the medical field with the physicians over-prescribing. I thought that, definitely, this was a big problem.”
Dentistry student Sarah Bettag, another study co-author, worked alongside Thomas to help collect data for the study. She said she thought the results of the study could also be empowering for dentists who were juggling being a dentist and maintaining a business.
“I thought this manuscript is a really strong message to dentists that even if you don’t prescribe opioids to patients, they will still be satisfied with their treatment and their pain will not increase,” Bettag said.
Currently, the American Dental Association’s policy on opioids limits prescriptions to seven days. Nalliah said that he thinks this limit is too high and unnecessary based on his personal research and other research findings. According to Nalliah, this study suggests opioids should only be prescribed for patients who can’t tolerate other pain medications like aspirin and ibuprofen.
“I think we can almost eliminate opioid prescribing from dental practice,” Nalliah said. “There’s going to be exceptions, like patients who can’t tolerate non-steroidal anti-inflammatories, however I would estimate that we could reduce opioid prescribing to about 10 to 15 percent of what we have historically prescribed as a profession.”
Nalliah said he hopes the results of the study takes the burden of balancing pain management and dosage off of dentists’ shoulders.
“I think that is an extremely liberating finding for dentists,” Nalliah said. “They want their patients to be pain-free, but at the same time, we know we are practicing in this current environment of the opioid crisis, and so we want to reduce the (amount) of opioids being prescribed.”
Daily Staff Reporter Francesca Duong can be reached at fduong@umich.edu