University of Michigan School of Dentistry, Ann Arbor.
Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor.
JAMA Netw Open. 2020 Mar 2;3(3):e200901. doi: 10.1001/jamanetworkopen.2020.0901.
Dentists commonly prescribe opioids to relieve pain after tooth extraction. Understanding the differences in patient-reported outcomes between opioid users and nonusers could encourage the adoption of more conservative and appropriate prescribing practices in dental medicine.
To evaluate whether pain and satisfaction scores reported by patients who used opioids after tooth extraction were similar to the levels reported by patients with no opioid use.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted in the 14 dental clinics of the University of Michigan School of Dentistry. Eligible adult patients of these clinics who underwent routine or surgical extractions between June 1, 2017, and December 31, 2017, were contacted by telephone within 6 months of the procedure. Patients were surveyed about the type of extraction, use of prescription opioid (if given), use of nonopioid analgesics, pain levels, and satisfaction with care after the procedure. Data analysis was conducted from February 1, 2018, to July 31, 2018.
The primary outcome was self-reported pain as assessed by the question, "Thinking back, how would you rate your pain in the first week after your dental procedure?" with a 4-point pain scale of no pain, minimal pain, moderate pain, or severe pain. Secondary outcomes included self-reported satisfaction with care as assessed by a Likert scale ranging from 1 to 10, in which 1 was extremely dissatisfied and 10 was extremely satisfied.
The final cohort comprised 329 patients, of whom 155 (47.1%) underwent surgical extraction (mean [SD] age, 41.8 [18.1] years; 80 [51.6%] were men) and 174 (52.9%) underwent routine extraction (mean [SD] age, 52.4 [17.9] years; 79 [45.4%] were men). Eighty patients (51.6%) with surgical extraction and 68 (39.1%) with routine extraction used opioids after their procedure. In both extraction groups, patients who used opioids reported higher levels of pain compared with those who did not use opioids (surgical extraction group: 51 [63.8%] vs 34 [45.3%], P < .001; routine extraction group: 44 [64.7%] vs 35 [33.0%], P < .001). No statistically significant difference in satisfaction was found between groups after surgical extraction (median [interquartile range] scores: 9 [7-10] for nonopioid group vs 9 [8-10] for opioid group) and routine extraction (median [interquartile range] scores: 10 [8-10] for nonopioid group vs 9 [7-10] for opioid group).
This study found that patients who used opioids after tooth extraction reported significantly higher levels of pain compared with nonusers, but no difference in satisfaction was observed.
牙医通常会开阿片类药物来缓解拔牙后的疼痛。了解阿片类药物使用者和非使用者之间患者报告的结果差异，可能会鼓励在牙科医学中采用更保守和适当的处方实践。
评估拔牙后使用阿片类药物的患者报告的疼痛和满意度评分是否与未使用阿片类药物的患者的水平相似。
设计、地点和参与者：这是一项质量改进研究，在密歇根大学牙科学院的 14 个牙科诊所进行。2017 年 6 月 1 日至 12 月 31 日期间，在这些诊所接受常规或手术拔牙的成年患者在手术后 6 个月内通过电话联系。患者接受了关于拔牙类型、处方阿片类药物（如果使用）、非阿片类镇痛药使用、疼痛程度和术后护理满意度的调查。数据分析于 2018 年 2 月 1 日至 2018 年 7 月 31 日进行。
主要结果是通过问题“回想一下，您如何在拔牙后的第一周内评估自己的疼痛？”评估的自我报告疼痛，使用 4 分疼痛量表进行评估，范围为无痛、轻微疼痛、中度疼痛或剧烈疼痛。次要结果包括通过 1 到 10 的李克特量表评估的自我报告护理满意度，其中 1 表示非常不满意，10 表示非常满意。
最终队列包括 329 名患者，其中 155 名（47.1%）接受了手术拔牙（平均[标准差]年龄为 41.8[18.1]岁；80[51.6%]为男性），174 名（52.9%）接受了常规拔牙（平均[标准差]年龄为 52.4[17.9]岁；79[45.4%]为男性）。80 名（51.6%）接受手术拔牙的患者和 68 名（39.1%）接受常规拔牙的患者在手术后使用了阿片类药物。在这两个拔牙组中，使用阿片类药物的患者报告的疼痛水平均高于未使用阿片类药物的患者（手术拔牙组：51[63.8%] vs 34[45.3%]，P < .001；常规拔牙组：44[64.7%] vs 35[33.0%]，P < .001）。在手术拔牙和常规拔牙后，两组之间的满意度均无统计学差异（中位数[四分位距]评分：非阿片类药物组为 9[7-10]，阿片类药物组为 9[8-10]；非阿片类药物组为 10[8-10]，阿片类药物组为 9[7-10]）。
这项研究发现，拔牙后使用阿片类药物的患者报告的疼痛水平明显高于非使用者，但未观察到满意度的差异。
