Aminoshariae Anita, Kulild James C, Donaldson Mark, Hersh Elliot V
J Am Dent Assoc. 2016 Oct;147(10):826-39. doi: 10.1016/j.adaj.2016.05.010. Epub 2016 Jul 28.
The purpose of this investigation was to identify evidence-based clinical trials to aid dental clinicians in establishing the efficacy for recommending or prescribing analgesics for pain of endodontic origin.
The authors prepared and registered a protocol on PROSPERO and conducted electronic searches in MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov. In addition, the authors manually searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled trials. Two authors selected the relevant articles independently. There were no disagreements between the authors.
The authors analyzed 27 randomized, placebo-controlled trials. The authors divided the studies into 2 groups: preoperative and postoperative analgesic treatments. There was moderate evidence to support the use of steroids for patients with symptomatic irreversible pulpitis. Also, there was moderate evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively or postoperatively to control pain of endodontic origin. When NSAIDs were not effective, a combination of NSAIDs with acetaminophen, tramadol, or an opioid appeared beneficial.
NSAIDs should be considered as the drugs of choice to alleviate or minimize pain of endodontic origin if there are no contraindications for the patient to ingest an NSAID. In situations in which NSAIDs alone are not effective, the combination of an NSAID with acetaminophen or a centrally acting drug is recommended. Steroids appear effective in irreversible pulpitis.
本研究的目的是确定基于证据的临床试验，以帮助牙科临床医生确定推荐或开处治疗牙髓源性疼痛的镇痛药的疗效。
作者在PROSPERO上制定并注册了一项方案，并在MEDLINE、Scopus、Cochrane图书馆和ClinicalTrials.gov进行了电子检索。此外，作者还手动检索了所有相关文章的参考文献、灰色文献和教科书，以查找随机对照试验。两名作者独立选择了相关文章。作者之间没有分歧。
作者分析了27项随机、安慰剂对照试验。作者将这些研究分为两组：术前和术后镇痛治疗。有中等证据支持对有症状的不可逆性牙髓炎患者使用类固醇。此外，有中等证据支持术前或术后使用非甾体抗炎药（NSAIDs）来控制牙髓源性疼痛。当NSAIDs无效时，NSAIDs与对乙酰氨基酚、曲马多或阿片类药物联合使用似乎有益。
如果患者没有服用NSAIDs的禁忌证，NSAIDs应被视为减轻或最小化牙髓源性疼痛的首选药物。在NSAIDs单独使用无效的情况下，建议将NSAIDs与对乙酰氨基酚或中枢作用药物联合使用。类固醇在不可逆性牙髓炎中似乎有效。
