Selecting new drugs for pain control: evidence-based decisions or clinical impressions?

BACKGROUND: Selecting drugs for pain control in dentistry should be based on scientific research rather than clinical impressions. This article highlights the scientific attributes of analgesic medications that make them practical for treating postoperative dental pain.
METHODS: This article is based on a review of the general characteristics of double-blind, controlled clinical studies compared with clinical observation in dental practice. The literature reviewed included all recent published clinical studies in refereed journals pertinent to the use of rofecoxib, a selective cyclo-oxygenase-2, or COX-2, inhibitor, in treating postoperative dental pain. The author focuses on some pharmacokinetic parameters of this agent as they compare with those of nonselective COX-2 inhibitors used to control dental pain. (The other selective COX-2 inhibitors, celecoxib and valdecoxib, do not carry label indications for short-term management of postoperative pain.)
RESULTS: The findings of this literature review show that the COX-2-selective inhibitor rofecoxib is no more effective than conventional, nonselective, nonsteroidal anti-inflammatory drugs, or NSAIDs, for the relief of postoperative dental pain. Rofecoxib does, however, have the disadvantage of requiring rescue medication from a different class of drugs in a significant number of patients.
CONCLUSIONS: The currently available COX-2-selective inhibitors do not replace conventional NSAIDs for the short-term treatment of postoperative dental pain. However, they are useful for treating chronic pain conditions because they produce fewer adverse effects when taken long-term than do conventional NSAIDs. CLINICAL IMPLICATIONS: Selecting drugs for the short-term relief of postoperative dental pain should be based on a careful assessment of all relevant pharmacological characteristics of a given agent, especially those related to maximum dosage, duration of action and efficacy.