Spring 2018

18 New Mexico Dental Journal, Spring 2018 • NSAIDs and APAP, taken simultaneously, work synergistically to rival opioids in their analgesic effect, but dosage levels and times of administration should be carefully documented to prevent overdosage. • When indicated for acute breakthrough pain, consider short-acting opioid analgesics. If opioid analgesics are considered, start with the lowest possible effective dose and the shortest duration possible. • When prescribing opioids, state law may require prescribers to access the state prescription drug- monitoring program (PDMP). If there is any suspicion of patient drug misuse, abuse and/ or addiction, the OMS should access the PDMP. To assess for opioid misuse or addiction, use targeted history or validated screening tools. • All instructions for patient analgesia and analgesic prescriptions should be carefully documented. • When deviating from these prescribing guidelines— or those required by state laws or institutions—the oral and maxillofacial surgeon (dentist) should document the justification for doing so. Dental and Medical providers should also: • Address exacerbations of chronic or recurrent pain conditions with non-opioid analgesics, non- pharmacological therapies and/or referral to specialists for follow-up, as clinically appropriate. • Limit the prescriptions of opioid analgesics to patients currently taking benzodiazepines and/or other opioids because of the risk factors for respiratory depression. • Dental providers should avoid starting treatment with long-acting or extended-release opioid analgesics. • Inform patients that the recommended maximum daily dose of acetaminophen should not exceed 3,000 mg. To avoid potential APAP toxicity, an oral and maxillofacial surgeon choosing to prescribe an opioid should consider one that is ibuprofen-based. • Counsel patients that the recommended maximum daily dose of ibuprofen is 3,200 mg. Note: Higher maximal daily doses have been reported for osteoarthritis while under the direction of a physician. • Educate patients on the expectations of postoperative pain management and the anticipated levels of relief. • Not prescribe acetaminophen with codeine to treat pain in children younger than 12. For more information, visit the FDA Drug Safety site. Formanagement of chronic pain, refer to the Centers for Disease Control’s Guideline for Prescribing Opioids for Chronic Pain. References This article was reprinted with permission from AAOMS. It is a modification of the AAOMS White paper entitled the same. The article is the product of the AAOMS opioid task force for which I am a contributing member.compliance and regulations. continued from page 17