Pain

Prompts to reduce opioid prescribing

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An interesting study with a potential technique to reduce opioid prescribing is published in Nature Communications by Doctor, J.N., Kelley, M.A., Goldstein, N.J. et al. titled A randomized trial looking at planning prompts to reduce opioid prescribing (vol.15, no. 263, 2024). The article suggests informing doctors about patients who died from overdoses, combined with specific guidance on safer prescribing practices, may be an effective way to reduce risky prescriptions of opioids and benzodiazepines. Despite efforts in the U.S. to reduce opioid addiction and related fatalities, it is believed too many opioids are still prescribed. Some evidence has shown that notifying doctors about an overdose death of a patient may be effective. Researchers from the University of Southern California investigated this approach by sending personalized letters to clinicians in Los Angeles County. Some received letters simply notifying them about a patient’s overdose death, while others received … Read more

Dentists increasingly use articaine 

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An interesting article titled “Survey investigation of articaine use in the United States,” written by Robert D. Bowers and et. al. appears in the the Journal of the American Dental Association (published Oct. 2023). The article conducted a study to expand the knowledge of local anesthesia practices of dentists in the U.S. with a specific focus on influencing factors regarding articaine. The U.S. Food and Drug Administration approved the use of articaine in 2000 and dental use of articaine has grown over the years. In 2017, it was estimated that estimate about 40% of the total U.S. dental local anesthetic market was for articaine. However, articaine has a 4% concentration which has led some to question its safety. Past studies have shown that higher concentrated local anesthetics like articaine can lead to increased risk of dental paresthesia. To study the use … Read more

Intravenous Ketamine During Surgery

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A review articled carried out by the Cochrane Database of Systematic Reviews titled “Perioperative intravenous ketamine for acute postoperative pain in adults” written by Brinck et al. in 2018 (no. 12, art. no. CD012033) explored the efficacy and safety of intravenous ketamine in adults for pain management while having surgery under general anesthesia. The authors sought randomized, double-blind, controlled trials for inclusion in their analysis. The main outcomes were opioid consumption and pain intensity at 24 and 48 hours after surgery. The authors included 130 studies with 8,341 participants. Types of surgery included wisdom teeth extraction and among many others like lumbar fusion surgery, anterior cruciate ligament (ACL) repair, abdominal surgery, and elective caesarean section. The researchers found by looking at 65 of these studies that perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine … Read more

FDA warns about dental problems from buprenorphine

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The U.S. Food and Drug Administration (FDA) has issued a safety concern regarding the medication buprenorphine which is a medication used to treat opioid use disorder, acute pain, and chronic pain. Buprenorphine is often used to reduce opioid withdrawal symptoms and the desire to use opioids, without causing the cycle of highs and lows associated with abusing opioid. The FDA warning issued on January 12, 2022, states that dental problems have occured when patients take medicines containing buprenorphine that are dissolved in the mouth. In the warning, the FDA said that the dental problems can include those of tooth decay, cavities, loss of teeth, and oral infections, and can occur in those without prior dental issues. As a result of this warning, the risk of dental problems occuring will be added to the prescribing information and the patient Medication Guide … Read more

FDA Issues Alert to Prevent Lidocaine 2 Percent Solution to Not be Used for Teething Pain for Children

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On June 26, 2014, the FDA issued an alert warning health professionals and providers that “…prescription oral viscous lidocaine 2% solution should not be used to treat infants and children with teething pain.” The FDA says that topical pain relievers and other medications that are rubbed on the gums are not useful for infants because they wash out of the mouth within minutes. Furthermore, when too much viscous lidocaine is given to children and is swallowed it can result in brain injury, seizures, heart problems, and even death. The FDA alert is located over at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm402790.htm. In the background information it states “In 2014, FDA reviewed 22 case reports of serious adverse reactions, including deaths, in infants and young children 5 months to 3.5 years of age who were given oral viscous lidocaine 2 percent solution for the treatment of … Read more