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- Opioid pain medications
have an important role
in the treatment of
acute postoperative pain.
However, they are also highly addictive.
After surgery, many patients receive
prescriptions for two to five times
more doses than they actually use.
This overprescribing of opioids
has contributed to the current
addiction epidemic in the United States.
The addiction risk
affects not only patients,
but, also, their families and friends.
2/3 of individuals who become addicted
began using leftover pills
prescribed for others.
Adolescents and young adults
are especially at risk for opioid misuse
and vulnerable to becoming addicted.
One strategy to address the opioid crisis
is to reduce opioid prescriptions
by optimizing pain management
with nonaddictive medications.
Nonsteroidal anti-inflammatory
drugs, or NSAIDs,
are such nonaddictive analgesics.
With support from the Penn
Center for Precision Medicine,
we have formed a multidisciplinary team
of researchers, pain
physicians, and oral surgeons
to develop a personalized approach
for postoperative pain
management with NSAIDs.
We are initially focusing
on impacted third-molar
or wisdom tooth extraction surgery,
because this is often the first occasion
adolescents and young adults
are described an opioid.
NSAIDs can be as effective
as prescription opioids in treating pain
following third-molar extraction surgery.
However, some patients experience
only limited pain relief with NSAIDs
and a few experience
no pain relief at all.
To avoid undertreating those patients,
opioids are routinely prescribed.
This results in an
overprescription of opioids
in the majority of patients
who do not require them
or require only minimal dosing.
Can we predict those individuals
in whom NSAIDs may be used effectively
and opioids avoided?
To address this question,
we are conducting a clinical trial
which systematically explores
the variability and pain relief
with the NSAID ibuprofen.
We are investigating genetic
and epigenetic factors that may predict
the inflammatory response
following surgery
and how that influences the degree
of pain relief with ibuprofen.
Being able to identify patients in advance
who will have substantial
pain relief with an NSAID
will help limit unnecessary
prescriptions of opioids.
And, importantly, this will also ensure
that patients who are unlikely
to achieve pain relief with an NSAID alone
have access to additional analgesics.
I am Dr. Tilo Grosser,
and this is Precision Medicine at Penn.
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