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    The Opioid Analgesic Reduction Study (OARS)-a comparison of opioid vs. non-opioid combination analgesics for management of post-surgical pain: a double-blind randomized clinical trial.

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    Author
    Feldman, Cecile A
    Fredericks-Younger, Janine
    Lu, Shou-En
    Desjardins, Paul J
    Malmstrom, Hans
    Miloro, Michael
    Warburton, Gary
    Ward, Brent
    Ziccardi, Vincent
    Fine, Daniel
    Date
    2022-02-17
    Journal
    Trials
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
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    See at
    https://doi.org/10.1186/s13063-022-06064-8
    Abstract
    BACKGROUND: Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid-seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription, a patient's risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the USA, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient's risk for addiction. METHODS: A double-blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid-containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision-making tool, pain management, extraction difficulty, and the number of tablets taken are being collected, enabling an experimental decision-making tool to be developed. DISCUSSION: The proposed methods address the shortcomings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 h. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, related either to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management. TRIAL REGISTRATION: ClinicalTrials.gov NCT04452344 . Registered on June 20, 2020.
    Rights/Terms
    © 2022. The Author(s).
    Keyword
    Acute pain
    Combination analgesics
    Impact third molar extraction
    Opioid-related side effects
    Opioids
    Over-the-counter analgesics
    Pain interference
    Pain management
    Satisfaction
    Sleep quality
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18102
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13063-022-06064-8
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