Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

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Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

Author(s): Steven J Scrivani , David A Keith , Ronald J Kulich , Alexandre F DaSilva , R Bruce Donoff , Shruti Handa , Nicole Holland , Mark A Lerman , Jenna L McCauley , Lori Reisner , Cory M Resnick , Christian S Stohler , Alexis Vasciannie , Matthew Fortino , Michael E Schatman

Publication date Created: 2021

Publication date (Electronic): May 2021

Journal: Journal of Pain Research

Publisher: Informa UK Limited

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Abstract

<p class="first" id="d2825480e523"> <b>Abstract:</b> Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. We have brought together a group of national thought leaders and experts in this field who will share their insights on the current state of opioid prescribing in Dentistry and describe some of the exciting work being done in advancing pain management. </p><p id="d2825480e527">The learning objectives for this conference proceedings were: <div class="list"> <a class="named-anchor" id="d2825480e529">  </a> <ol style="list-style-type: 
					decimal
				"> <li id="d2825480e530"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e531">Describing the implications of current public health concerns for safe and effective pain management in dental medicine. </p> </div> </li> <li id="d2825480e533"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e534">Identifying risk factors and understanding the current guidelines for the use of opioid and non-opioid medications in dental medicine. </p> </div> </li> <li id="d2825480e536"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e537">Analyzing the interprofessional collaborations necessary for effective pain management in dental medicine. </p> </div> </li> <li id="d2825480e539"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e540">Recognizing the challenges and opportunities brought about by the COVID-19 pandemic for the dental profession. </p> </div> </li> <li id="d2825480e542"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e543">Applying evidence-based strategies for managing the complex pain patient in the dental setting. </p> </div> </li> <li id="d2825480e545"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2825480e546">Appraising new and future modalities for the assessment and management of orofacial pain. </p> </div> </li> </ol> </div> </p>

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Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, 'missing' heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment.

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Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

Luis Sordo, Gregorio Barrio, María J. Bravo … (2017)

Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, and LILACS to September 2016. Study selection Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine. Data extraction and synthesis Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis. Results There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment. Conclusions Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.