Gabapentin, in combination with other analgesics, can help manage toothache pain.
Gabapentin, an anticonvulsant drug, has been found to be beneficial in managing dental pain, particularly when used in combination with other analgesics. Here are some of the benefits of using gabapentin for dental pain:
- Effective Pain Management: Gabapentin, when combined with other non-opioid pain medications like ibuprofen or acetaminophen, has been found to be effective in relieving dental pain, particularly after tooth extractions.
- Reduced Opioid Use: The use of gabapentin in combination with other analgesics can help minimize or even eliminate the need for opioids in managing dental pain. This is particularly important given the ongoing concerns about opioid addiction and misuse.
- Lower Failure Rates: In a study conducted at the University of Rochester Medical Center’s Eastman Institute for Oral Health, non-opioid medications, including those with gabapentin, had failure rates significantly lower than opioids. The failure rate refers to how often patients returned to the clinic for additional pain relief.
- Postoperative Pain Management: Gabapentin has been found to be effective in managing established acute postoperative pain. In a study, a single dose of gabapentin 250 mg was found to be statistically superior to placebo in the treatment of established acute postoperative pain.
Appropriate Use
When prescribed and used correctly in normal doses, gabapentin can be effective in treating chronic pains such as neuropathy, fibromyalgia, and pain of unknown origin. While it doesn’t work for all patients and isn’t a cure-all, for those suffering from debilitating pain, gabapentin can help make the pain bearable when no other options are available.
Potential for Abuse
However, gabapentin also has potential for abuse when individuals who rely on opioids for chronic pain find that very high doses of the medication can produce euphoric effects similar to opioids. As gabapentin generally does not show up in blood or urine tests, it has become a covert drug of abuse among those seeking pain relief but wishing to avoid opioid detection.
Risks at High Doses
Taking excessively high doses of gabapentin is extremely dangerous. As an antiepileptic drug, excessive doses can paradoxically cause seizures. Additionally, combining gabapentin with opioids and benzodiazepines significantly increases the risk of respiratory depression.
Therefore, while gabapentin can be useful when used correctly, it also has a high potential for abuse and serious side effects at excessive doses. Patients and providers must be aware of these risks when considering the use of this medication.
Implications for Dental Treatment
If a patient is taking gabapentin, the dentist should exercise caution when administering local anesthetics or opioids. The lowest effective dose of local anesthetic should be used to minimize effects on the cardiovascular and central nervous system. Additionally, a complete medical history, including all medications the patient is taking, should be obtained to properly assess the risks of dangerous drug interactions.
Evidences for tooth pain
A study published in JAMA Network Open found that a multimodal analgesia strategy using nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and gabapentin was effective in treating dental pain and minimizing the use of opioids[1]. However, gabapentin is not typically used as a first-line treatment for toothache pain, and it is essential to consult a healthcare professional for appropriate treatment options.
It is important to note that gabapentin is primarily prescribed for nerve pain and epilepsy[3]. While some anecdotal reports suggest that gabapentin may help with toothache pain[6], it is not specifically approved for this purpose. It is always best to consult a dentist or healthcare provider for proper diagnosis and treatment of toothache pain.
Precautions when taking Gabapentin
When using gabapentin for dental pain, there are several precautions to consider:
- Dosage and Administration: Gabapentin should be taken only as directed by a healthcare professional. It’s important not to take more of it, take it more often, or take it for a longer time than prescribed[1].
- Interactions with Other Medications: Gabapentin can interact with other sedating medications such as opioids, which can lead to impairment, accidents, and potentially increase the risk of overdose[2]. It can also interact with antacids that contain aluminum or magnesium, so it’s recommended to wait at least 2 hours before taking gabapentin if you’ve taken these antacids[1].
- Potential for Misuse: Gabapentin has potential for misuse, particularly among opioid-dependent patients. It’s important for healthcare professionals to be aware of this risk when prescribing the drug[2].
- Side Effects: Gabapentin may cause side effects such as vision changes, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking[6]. If these side effects are especially bothersome, it’s recommended to check with a healthcare professional[6].
- Respiratory Depression: Gabapentin can cause respiratory depression, a serious breathing problem that can be life-threatening, especially when used together with narcotic pain medicines[1][6].
- Abrupt Discontinuation: Do not stop using gabapentin without checking with your doctor. Stopping the medicine suddenly may cause seizures. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely[6].
- Alcohol Consumption: Avoid drinking alcohol while taking gabapentin as it could increase sleepiness or dizziness[10].
- Inform Healthcare Providers: Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests[4][10].
Gabapentin interactions
Gabapentin, an anticonvulsant drug, can interact with several other medications when used for dental pain:
- Opioids: Gabapentin can interact with opioids, leading to increased sedation, impairment, and potentially raising the risk of overdose[1][6]. This interaction can also increase the risk of respiratory depression, a serious breathing problem that can be life-threatening[7].
- Sedating Medications: Gabapentin can interact with other sedating medications, leading to additive adverse effects and potentially serious drug-drug interactions[6].
- Antacids Containing Aluminum or Magnesium: If you take an antacid that contains aluminum or magnesium, it’s recommended to wait at least 2 hours before taking gabapentin[5].
- Central Nervous System (CNS) Depressants: Pairing gabapentin with any CNS depressant, such as benzodiazepines, sedating antidepressants, sedating antipsychotics, antihistamines, etc., may increase the risk of respiratory depression[7].
- Xylocaine Dental: No interactions were found between gabapentin and Xylocaine Dental. However, this does not necessarily mean no interactions exist[2].
It’s important to note that these interactions can lead to increased side effects and potential risks. Therefore, it’s crucial to inform your healthcare provider about all the medications you are currently taking before starting gabapentin.
Always consult your healthcare provider for personalized medical advice.
Citations:
[1] https://www.healio.com/news/psychiatry/20220819/analgesics-in-combination-with-gabapentin-just-as-effective-as-opioids-for-dental-pain
[2] https://www.drbicuspid.com/dental-specialties/orofacial-pain/article/15378587/dental-dose-how-patients-use-gabapentin-illicitly
[3] https://www.nhs.uk/medicines/gabapentin/how-and-when-to-take-gabapentin/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170897/
[5] https://www.mayoclinic.org/drugs-supplements/gabapentin-oral-route/proper-use/drg-20064011?p=1
[6] https://www.drugs.com/answers/gabapentin-300-mg-cap-amneal-toothache-tooth-pain-687976.html
[7] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795252
[8] https://www.sciencedirect.com/science/article/pii/S1348864311000024
[9] https://www.painnewsnetwork.org/stories/2022/8/19/should-gabapentin-be-prescribed-for-dental-pain
[10] https://www.goodrx.com/gabapentin/dosage-guide
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536948/
[12] https://www.urmc.rochester.edu/news/story/new-eastman-institute-study-shows-promising-alternative-to-opioids-for-pain-after-tooth-extractions
[13] https://youtube.com/watch?v=JhaFzOq-Ei8
M.D. Orthopaedic Pain Management - University of São Paulo