J Am Dent Assoc. 2022 Jun;153(6):511-520.e13. doi: 10.1016/j.adaj.2021.11.001. Epub 2022 Feb 28.
Little is known about how opioid prescribing differs for dental procedures with low, moderate, or high pain or whether that prescribing is associated with continued opioid use.
The authors used Pennsylvania Medicaid claims data from 2012 through 2017. They categorized dental procedures into 3 groups of pain (low, moderate, high). Using multivariable logistic regression models with random intercept, the authors estimated the probability of receiving an initial opioid prescription within 7 days before and 3 days after a dental procedure associated with the pain categories and assessed subsequent short- and long-term (4-90 days and 91-365 days, respectively) opioid use.
The authors identified 1,345,360 index dental procedures (among 912,121 enrollees), of which 67.6% were categorized as low pain, 1.6% as moderate pain, and 30.9% as high pain. Predicted probability of an initial opioid prescription was 2.4% (95% CI, 2.4% to 2.5%) for low-pain, 8.3% (95% CI, 7.9% to 8.6%) for moderate-pain, and 31.8% (95% CI, 31.6% to 31.9%) for high-pain procedures. Predicted probabilities for short-term use for those who did not fill versus those who did fill an opioid prescription were 0.9% (95% CI, 0.9% to 1.0%) versus 25.0% (95% CI, 24.5% to 25.6%) for the low-pain, 1.6% (95% CI, 1.4% to 1.8%) versus 16.6% (95% CI, 14.9% to 18.4%) for moderate-pain, and 2.9% (95% CI, 2.8% to 3.0%) versus 13.5% (95% CI, 13.3% to 13.7%) for the high-pain groups.
Although enrollees undergoing high-pain dental procedures were more likely to fill an initial opioid prescription than their counterparts with low- to moderate-pain procedures, the relative risk of experiencing sustained opioid use (4-90 days postprocedure) was highest in the low-pain group.
More attention should be paid to reducing opioid prescribing for dental procedures with low pain risk.
对于低、中、高疼痛程度的牙科手术，阿片类药物的处方有何不同，以及这种处方是否与持续使用阿片类药物有关，目前知之甚少。
作者使用了 2012 年至 2017 年宾夕法尼亚州医疗补助索赔数据。他们将牙科手术分为疼痛程度低、中、高 3 组。作者采用具有随机截距的多变量逻辑回归模型，估计与疼痛类别相关的牙科手术后 7 天内和 3 天内首次开具阿片类药物处方的概率，并评估随后的短期（4-90 天）和长期（91-365 天）阿片类药物使用情况。
作者确定了 1345360 例索引牙科手术（涉及 912121 名参保人），其中 67.6%为低疼痛，1.6%为中度疼痛，30.9%为高疼痛。低疼痛组初始阿片类药物处方的预测概率为 2.4%（95%CI，2.4%至 2.5%），中疼痛组为 8.3%（95%CI，7.9%至 8.6%），高疼痛组为 31.8%（95%CI，31.6%至 31.9%）。未开阿片类药物处方和开阿片类药物处方者短期（4-90 天）使用的预测概率分别为 0.9%（95%CI，0.9%至 1.0%）和 25.0%（95%CI，24.5%至 25.6%），低疼痛组为 1.6%（95%CI，1.4%至 1.8%）和 16.6%（95%CI，14.9%至 18.4%），中疼痛组为 2.9%（95%CI，2.8%至 3.0%）和 13.5%（95%CI，13.3%至 13.7%）。
尽管接受高疼痛牙科手术的参保人更有可能开具初始阿片类药物处方，但与低至中度疼痛手术相比，持续使用阿片类药物（术后 4-90 天）的相对风险在低疼痛组最高。
对于低风险疼痛的牙科手术，应更加关注减少阿片类药物的处方。
