No More Horse Pills? Intranasal Non-Opioid Pain Relief For Dental, Orofacial, & Endodontic Pain

As dental professionals seek non-opioid alternatives to help patients control and manage moderate to severe pain, researchers and pharmacists are reaching deeper into their pharmacologic bag of tricks to find combinations that can offer patients quick, meaningful relief.

Those measures—speed of relief and meaningful relief¬—were two of the measures evaluated in a recent double-blind evaluation of Ketorolac, a nonsteroidal analgesic anti-inflammatory drug (NSAID) that differs from other drugs in the same class via its route of administration.

Patented in the 1976 and approved for medical use in 1989, Ketorolac is a first-generation NSAID and was approved for intranasal delivery in 2010 for short-term (five days or less) management of moderate to severe pain—that is, pain requiring relief at the opioid level.

Endodontic and orofacial pain requiring such relief are among the most common types of pain patients experience in dentistry.

While other studies of Ketorolac for dental pain control have been conducted, with mixed results, the most recent study compared the drug, delivered intranasally (taken along with placebo capsules to construct the double-blind condition), with a combination of 600 mg ibuprofen and 1000 mg of acetaminophen—a combination that has been previously found as effective as opioids for dental pain relief.

Study participants were asked to record their pain perception every 15 minutes after receiving either Ketorolac or the acetaminophen/ibuprofen and placebo nasal spray combo.

In both test conditions, patients experienced similar timing of initial pain relief, meaningful pain relief, and 50% relief of initial pain.

Time to pain relief in minutes

Time point

Acetaminophen/
ibuprofen
Intranasal ketorolac

p-value

1st sign of pain relief

39 ± 32 42 ± 29 0.6241
Meaningful pain relief 67 ± 44 79 ± 39 0.2522
50% relief of initial pain 70 ± 35 87 ± 50 0.1267

(Table Source: DrBicuspid.com)

But as with all pharmaceuticals, taking a thorough medical history and updating the current medication list (including herbs and supplements) before prescribing any novel drug is critical to safeguarding patient health. Ketorolac interacts with other medications; bleeding is a known risk. Other NSAIDs, alcohol, corticosteroids, potassium supplements, and aspirin are contraindicated with Ketorolac, as are many nutritional supplements that can thin the blood, such as dong quai, ginger, panax ginseng, arnica, and large doses of fish oil.

Other side effects of nasal Ketorolac administered nasally may include irritation and discomfort in the nasal passages as well as upset stomach, nausea, dizziness and drowsiness, which patients should be alerted to before taking the drug.

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