pain management

Using Low Dose Naltrexone for Treating Burning Mouth Syndrome

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An interesting article titled “Low Dose Naltrexone for Treatment of Burning Mouth Syndrome” appears in Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology written by L. Sangalli and C. S. Miller (Published April 30, 2022). The article discusses using a low dosage of naltrexone to treat burning mouth syndrome (BMS) that started after a woman had a tooth extraction. In the article discussion is made of a 62 year old woman who had been experiencing BMS the the last three years. She had had a tooth extracted three years earlier and the pain she was experiencing was at the site of the extraction. After some time pain went away but then a year or so after the extraction the woman began experiencing BMS at the dorsum of her tongue. She reported tingling and burning sensations and the pain flucated between … Read more

Visualization of Facial Pain Sensory Signaling

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An interesting article titled “Visualization of trigeminal ganglion sensory neuronal signaling regulated by Cdk5,” written by M. Hu and et al. appears in the 2022 editon of Cell Reports (Mar 8, vol. 38, no. 10, pp. 110458). The article seeks to explore some of the mechanisms underlying facial pain and used intravital imaging to compare trigeminal neuronal activities after mechanical, thermal, and chemical stimulation. The work was carried out by researchers for the NIH’s National Institute of Dental and Craniofacial Research. Orofacial pain that occurs in the oral and facial region affects 5% to 12% of the U.S. population. This pain can affect daily activities and causes many to seek medications like opioids for releif, but opioids can be addicting. Thus researchers are interested in learning more about how facial nerves process pain signals to help lead to more efficeitn … 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

Low-Dose Naltrexone as An Alternative to Opioids for Wisdom Teeth Removal

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Before on this site numerous posts have discussed how many feel dentists and oral surgeons prescribe (or in the past have prescribed) too many opioids for their patients to help manage pain of dental procedures like wisdom teeth removal, see for example the post Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal?. In recent years there have been investigations into alternatives to opioids for dental procedures and also for chronic pain management when opioids in the past were more regularly prescribed for as well. One such approach is to prescribe a combination of ibuprofen and acetaminophen as discussed in the articles New Research Being Conducted at Rutgers for Opioid Alternatives Could Lead to Less Potential Drug Abuse for those Having Wisdom Teeth Surgery and Reducing Opioids in Oral and Maxillofacial Surgery. Recently, there have been articles and … Read more