Opioid-free pain management guidelines released by Pitt Dental Medicine

The University of Pittsburgh School of Dental Medicine is the first in the nation to establish opioid-free pain management guidelines for the vast majority of procedures performed in all of its clinics.

For decades, opioid pain relievers have been routinely prescribed for dental procedures, including the surgical extraction of wisdom teeth – often a teenager's first exposure to opioids. Since current evidence shows that alternative, non-opioid medications generally work as well or even better for managing pain after dental work, without the side effects of nausea, vomiting, constipation and potential for misuse, Pitt Dental Medicine has developed a set of updated pain management guidelines to help practitioners make the best choices for their patients.

It's not a cookbook approach to how to take care of patients. This allows clinicians to make good choices based on what they know of the biology of the patient and the patient's concerns.

Bernard J. Costello, D.M.D., M.D. dean of the Pitt School of Dental Medicine

The Pitt Dental Medicine guidelines advocate that clinicians prescribe non-opioid pain-relievers first whenever possible.

If a patient can't tolerate one of several opioid alternatives, or requires additional pain relief as a rescue medication, clinicians should:

• Choose the lowest potency possible.
• Limit to a three-day supply.
• Check the Pennsylvania Patient's Prescription Drug Monitoring Program (PDMP) database.

If the patient is already taking opioids for chronic pain or a substance use disorder, additional opioids should not be prescribed without first consulting a pain management clinician and formulating an alternative plan.

The Appalachian corridor, which includes Western Pennsylvania, is a hot zone for opioid addiction. With deaths occurring every day from opioid abuse, and costs of rehabilitation care approaching $90,000 per hospitalization, deliberate strategies to minimize dental pain after treatment and eliminate the need for opioid pain relievers are now available to combat this public health crisis in the Appalachian region.

"Pitt Dental Medicine is leading the way with the adoption of this new protocol by teaching our students and residents the best way to manage pain effectively without the unnecessary risk of opioid dependence," Costello said. "When these trainees move on to other practices, they'll take these opioid-free guidelines with them."