Aminoshariae A, JC, Pain of endodontic origin Various not well Various drugs, doses Systematic review of 27 This review did not – Donaldson M et al. (2016). described and methods of cohort- randomized specifically examine the Preoperative and Evidence-based administration placebo-controlled trials. issue of whether low-dose postoperative recommendations for codeine combinations are Moderate evidence to (oral, intramuscular analgesic efficacy to treat pain more effective than the support nonsteroidal or injection at of endodontic origin: A opiate in the combination inflammatory trial periapical site) systematic review of alone. (NSAIDs) preoperatively or randomized controlled trials. J postoperatively to control The authors’ Am Dent Assoc. July 28. pain of endodontic origin. recommendations for adding a centrally acting When NSAIDs were not drug are based on studies effective, a combination of that included morphine, NSAIDs with tramadol, oxycodone, acetaminophen, tramadol, hydrocodone or high dose or an opioid appeared codeine (60mg) beneficial. combinations. Authors’ conclusion: NSAIDs should be This paper does not provide considered as the drugs of evidence for the incremental choice to alleviate or analgesic effectiveness of minimize pain of low-dose codeine endodontic origin if there combination products over are no contra-indications the non-opiate in the for the patient to ingest an combination. NSAID. In situations in There was no safety which NSAIDs alone are information in the paper. not effective, the combination of an NSAID with acetaminophen or a centrally acting drug is recommended. Steroids appear effective in irreversible pulpitis.
Aminoshariae A, JC, Donaldson M et al. (2016). Evidence-based recommendations for analgesic efficacy to treat pain of endodontic origin: A systematic review of randomized controlled trials. J Am Dent Assoc. July 28. Pain of endodontic origin Preoperative and postoperative Various – not well described Various drugs, doses and methods of administration (oral, intramuscular or injection at periapical site) Systematic review of 27 cohort- randomized placebo-controlled trials. Moderate evidence to support nonsteroidal (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. Authors’ conclusion: NSAIDs should be considered as the drugs of choice to alleviate or minimize pain of endodontic origin if there are no contra-indications 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. This review did not specifically examine the issue of whether low-dose codeine combinations are more effective than the in the combination alone. The authors’ recommendations for adding a centrally acting drug are based on studies that included morphine, tramadol, oxycodone, hydrocodone or high dose codeine (60mg) combinations. This paper does not provide evidence for the incremental analgesic effectiveness of low-dose codeine combination products over the non-opiate in the combination. There was no safety information in the paper. trial inflammatory opiate
update-codeine-safety-and-efficacy-review.docx