Philadelphia — With the Centers for Disease Control and Prevention estimating that more than 130 people in the United States die each day from overdosing on opioids, the misuse of and addiction to opioids has become a national health crisis. In conjunction with the U.S. Food and Drug Administration (FDA), the National Academies of Sciences, Engineering and Medicine (NASEM) is working to help address this crisis as it relates to prescription opioids, establishing the NASEM Committee on Evidence-based Clinical Practice Guidelines for Prescribing Opioids for Acute Pain. Penn Dental Medicine’s Dr. Elliot Hersh, Professor of Pharmacology, was among a panel of clinician/scientists recently asked to present to this NASEM Committee as part of a workshop on identifying research gaps in clinical practice guidelines for prescribing opioids, speaking on pain management after third molar (wisdom teeth) extractions. (View presentation >> )
This workshop, held July 9 at the National Academy of Sciences Building in Washington, DC, was the fourth meeting of the Committee since established in the fall of 2018. The goal of the workshop was to assist the Committee in developing a research agenda to address evidence gaps in a variety of clinical practice guidelines for prescribing opioids for several surgical and medical conditions. Dr. Hersh was asked to consider the Committee’s draft analytic framework for developing a clinical practice guideline for third molar extractions and discuss what evidence would be necessary to make the links in the framework or what additional information would bring existing clinical guidelines up to the standards indicated in the draft framework.
“In dentistry, I see two specific areas of concern – prescribing opioids when they aren’t indicated, and when indicated, prescribing too many opioid-containing pills,” says Dr. Hersh, an expert in the study of non-addicting pain relievers for postsurgical pain, who was recommended by NASEM panel members, including Dr. Rosemary Polomano, Professor of Pain Practice at Penn’s School of Nursing and a member of this NASEM Committee. Dr. Polomano emphasizes that: “Understanding the research for prescribing opioids for specific types of pain is critical to evidence-based practice. Dr. Hersh’s influential cutting-edge science shows that NSAIDs are most effective for many types of dental pain.”
“The analgesic efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative dental pain has been firmly established for many years,” says Dr. Hersh. “However, evidence-based data supporting the use of NSAIDs over opioids following dental impaction surgery has been slow to translate into clinical practice.”
In addition to Dr. Hersh’s presentation on the use of prescription opioids with third molar extractions, the workshop included speakers on pain management for the surgical procedures of cesarean section and vaginal delivery and knee replacement therapy and the medical indications of sickle cell disease, musculoskeletal pain, and kidney stones.
Through this 16-month project, the NASEM Committee will develop a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications; recommend indications for which new evidence-based guidelines should be developed; and recommend a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids for acute pain indications. Sponsored by the FDA, the Committee’s work will produce recommendations for how to generate easily accessible, evidence-based, clinical practice guidelines for effectively managing acute pain with opioid drugs for specific medical procedures and conditions that the FDA could use as a reference in its publicly available materials.