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Drug Therapy in Dental Practice: Nonopioid and Opioid Analgesics
Daniel E. BeckerDDS and
James C. PheroDMD
Article Category: Other
Volume/Issue: Volume 52: Issue 4
Online Publication Date: Jan 01, 2005
DOI: 10.2344/0003-3006(2005)52[140:DTD]2.0.CO;2
Page Range: 140 – 149

. Figure 1. Nociceptive pathways. The drawing illustrates [A] incoming nociceptive impulses, [B] ascending nociceptive tracks, and [C] descending inhibitory tracts that act to blunt incoming pain signals. Abbreviations represent the myriad of neurotransmitters that contribute to pain transmission. They reflect potential targets for pharmacologic intervention to control pain. Conventional analgesics are classified as opioids and nonopioids, but the older terms ‘‘narcotic’’ and ‘‘non-narcotic’’ continue to be used interchangeably. Current research has

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Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study
Peggy ComptonRN, PhD,
Steven WangDMD, MD, MPH,
Camron FakharMD, DDS,
Stacey SecretoCCRC,
Olivia Halabicky ArnoldRN, PhD,
Brian FordMD, DMD, and
Elliot V. HershDMD, MS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 1
Online Publication Date: Mar 28, 2023
DOI: 10.2344/anpr-69-03-03
Page Range: 9 – 16

In well-intended and industry-driven efforts to provide relief to chronic pain sufferers, the prescription of opioids has dramatically increased since the turn of the century, such that it is currently estimated that over 5 million Americans use opioids on a daily basis. 1 Yet prescription opioid therapy for chronic pain is not an evidence-based intervention; as evaluation data accumulate, it is increasingly clear that health outcomes, including surgical outcomes, are poorer for patients on opioid therapy. 2 A theorized explanation for

Opioid Use Disorder in Dental Patients: The Latest on How to Identify, Treat, Refer and Apply Laws and Regulations in Your Practice
Bryan NackDMD,
Steven E. HaasDMD, JD, MBA, and
Jason PortnofDMD, MD, FACS
Article Category: Research Article
Volume/Issue: Volume 64: Issue 3
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-64-03-09
Page Range: 178 – 187

opioids. Despite comprising only 4% of the world's population, Americans consumed 80% of all opioids, and 99% of all hydrocodone. 3 From 1997 to 2005, prescriptions for hydrocodone and oxycodone rose 198% and 588%, respectively. 4 85% of the 79.5 million opioid prescriptions in 2009 contained either hydrocodone or oxycodone. 4 Opioid overdoses have accounted for more deaths than cocaine and heroin. 4 In 2015, 63.1% of the 52,404 drug overdose-related deaths involved an opioid. 5 Since 2013, the incidence of drug-use-related deaths has surpassed motor vehicle

Figure 2.; Seventy-Two–Hour Postoperative Pain Severity in Opioid-Using and Opioid-Naïve Patients. Increased perceived postoperative pain severity as measured with a visual analog scale (0 = no pain and 10 = severe pain; mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain.
Peggy Compton,
Steven Wang,
Camron Fakhar,
Stacey Secreto,
Olivia Halabicky Arnold,
Brian Ford, and
Elliot V. Hersh
Figure 2.
Figure 2.

Seventy-Two–Hour Postoperative Pain Severity in Opioid-Using and Opioid-Naïve Patients.

Increased perceived postoperative pain severity as measured with a visual analog scale (0 = no pain and 10 = severe pain; mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain.

Figure 3.; Analgesic Doses Taken During the First 72 Hours Postoperatively in Opioid-Using and Opioid-Naïve Patients. Patients with chronic pain on opioid therapy used more analgesics (mean, SD) during the first 72 hours postoperatively vs opioid-naïve patients without chronic pain.
Peggy Compton,
Steven Wang,
Camron Fakhar,
Stacey Secreto,
Olivia Halabicky Arnold,
Brian Ford, and
Elliot V. Hersh
Figure 3.
Figure 3.

Analgesic Doses Taken During the First 72 Hours Postoperatively in Opioid-Using and Opioid-Naïve Patients.

Patients with chronic pain on opioid therapy used more analgesics (mean, SD) during the first 72 hours postoperatively vs opioid-naïve patients without chronic pain.

Figure 3; Molecular structures of morphine, codeine, and derivatives. Codeine and its derivatives differ from their morphine-derived counterparts only in a methyl substitution (circled). This methyl group prevents adequate binding to the mu opioid receptor that mediates most opioid effects. However, these prodrugs are capable of producing nausea and constipation, which are problematic when high doses are administered to generate enough active metabolite for analgesia. (Asterisks indicate molecular alterations from morphine and codeine.)
Daniel E. Becker and
James C. Phero
Figure 3
Figure 3

Molecular structures of morphine, codeine, and derivatives. Codeine and its derivatives differ from their morphine-derived counterparts only in a methyl substitution (circled). This methyl group prevents adequate binding to the mu opioid receptor that mediates most opioid effects. However, these prodrugs are capable of producing nausea and constipation, which are problematic when high doses are administered to generate enough active metabolite for analgesia. (Asterisks indicate molecular alterations from morphine and codeine.)

Figure 1.; (a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients. Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.
Peggy Compton,
Steven Wang,
Camron Fakhar,
Stacey Secreto,
Olivia Halabicky Arnold,
Brian Ford, and
Elliot V. Hersh
Figure 1.
Figure 1.

(a) Cold-Pressor and (b) Heat Pain Tolerance and Severity in Opioid-Using and Ppioid-Naïve Patients.

Decreased pain tolerance and increased perceived pain severity (mean, SD) in patients with chronic pain on opioid therapy vs opioid-naïve patients without chronic pain across cold-pressor and heat pain assays.

Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions
Steven HalepasDMD, MD,
Cameron ChristiansenBS,
Alia KochDDS, MD,
Shahid R. AzizDMD, MD,
David M. ShaferDMD, and
Elie M. FerneiniMD, DMD, MHS, MBA
Article Category: Research Article
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-12
Page Range: 9 – 14

On October 26, 2017, the US Secretary of Health and Human Services declared the opioid crisis a national public health emergency. 1 The misuse and abuse of opioids in recent years has put much scrutiny on the prescribing habits of all health care providers. Millions of surgical procedures are done every year, and statistics suggest that patients' exposure to prescription opioids following surgery may ultimately lead to long-term use or abuse. In fact, 1 in 16 surgical patients becomes a long-term opioid user once prescribed opioids

The Opioid Challenge
Steven GanzbergDMD, MS
Article Category: Editorial
Volume/Issue: Volume 63: Issue 3
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.3.113
Page Range: 113 – 115

Most dental practitioners are aware of the increasing controversy in the United States surrounding the prescribing of opioids for postoperative pain. Fortunately, the use of opioids for surgery with general anesthesia and sedation is not a matter of concern in this controversy. It is understandable from a US public health standpoint that opioid prescribing should receive increasing scrutiny. In 2012, there were 259 million US opioid prescriptions, more than enough for 1 bottle for every adult in the United States. Since 1999, there

Diversity of Opioid Requirements for Postoperative Pain Control Following Oral Surgery—Is It Affected by Polymorphism of the μ-Opioid Receptor?
Ken-ichi FukudaDDS, PhD,
Masakazu HayashidaMD, PhD,
Kazutaka IkedaPhD,
Yoshihiko KoukitaDDS, PhD,
Tatsuya IchinoheDDS, PhD, and
Yuzuru KanekoDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 57: Issue 4
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.4.145
Page Range: 145 – 149

Individual differences in sensitivity to pain and to analgesics are known to vary among patients in daily clinical practice. The amount of analgesics, such as opioids, used for postoperative pain control, even following the same surgery, also varies substantially among patients. Factors possibly underlying these individual differences include environmental, psychological, and genetic factors. We conducted a study involving patients undergoing oral surgery to identify genetic and psychological factors responsible for the diversity of opioid