Peripheral Oploid Analgesia in Teeth with Symptomatic Inflamed Puips

The purpose of this study was to investigate the ability of low-dose fentanyl to produce analgesia when administered via the periodontal ligament injection in teeth with symptomatic, inflamed pulps. All subjects presented for emergency treatment with moderate to severe pain and had a posterior tooth with a clinical diagnosis of irreversible pulpitis. Twenty subjects randomly received either 10 ,ug fentanyl citrate or saline placebo via the periodontal ligament injection in a double-blind manner. The subjects rated their pain prior to injection and rated pain intensity and pain half gone for 59 min postinjection. Low-dose fentanyl delivered via the periodontal ligament injection in inflamed teeth provided significantly greater analgesia than the saline placebo (P < 0.05). Since the dose of fentanyl used was less than the dose required to provide analgesia by a central mechanism, the results of this study may be consistent with a peripheral opioid mechanism of action.

[1]  C. Stein,et al.  Perineurial defect and peripheral opioid analgesia in inflammation , 1995, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[2]  C. Stein Peripheral analgesic actions of opioids. , 1991, Journal of pain and symptom management.

[3]  C. R. Chapman,et al.  Steady-state infusions of opioids in human. II. Concentration-effect relationships and therapeutic margins , 1990, Pain.

[4]  R. Przewłocki,et al.  Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation. , 1990, Proceedings of the National Academy of Sciences of the United States of America.

[5]  G. Guilbaud,et al.  Potent and long lasting antinociceptive effects after injection of low doses of a mu-opioid receptor agonist, fentanyl, into the brachial plexus sheath of the rat , 1990, Pain.

[6]  A. Herz,et al.  Intrinsic mechanisms of antinociception in inflammation: local opioid receptors and beta-endorphin , 1990, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[7]  J. Levine,et al.  Involvement of the mu-opiate receptor in peripheral analgesia , 1989, Neuroscience.

[8]  Michael J. Cousins,et al.  Fentanyl Blood Concentration‐Analgesic Response Relationship in the Treatment of Postoperative Pain , 1988, Anesthesia and analgesia.

[9]  T. Shippenberg,et al.  Peripheral effect of fentanyl upon nociception in inflamed tissue of the rat , 1988, Neuroscience Letters.

[10]  R. Dubner,et al.  Opioid Analgesia at Peripheral Sites: A Target for Opioids Released during Stress and Inflammation? , 1987, Anesthesia and analgesia.

[11]  A. Reader,et al.  An ultrastructural investigation of the human apical pulp in irreversible pulpitis. II. Vasculature and connective tissue. , 1987, Journal of endodontics.

[12]  A. Reader,et al.  An ultrastructural investigation of the human apical pulp in irreversible pulpitis. I. Nerves. , 1987, Journal of endodontics.

[13]  J. Lipman,et al.  Local Analgesia without Anesthesia Using Peripheral Perineural Morphine Injections , 1987, Anesthesia and analgesia.

[14]  H. Schaible,et al.  Opiates inhibit the discharges of fine afferent units from inflamed knee joint of the cat , 1987, Neuroscience Letters.

[15]  G. B. Frank,et al.  Effects of enkephalin, applied intracellularly, on action potentials in vertebrate A and C nerve fibre axons , 1987, Neuropharmacology.

[16]  L. Kitahata,et al.  Lack of opiate effects on cat C polymodal nociceptive fibers , 1986, Pain.

[17]  F. Knudsen,et al.  Perineural morphine for the relief of chronic pain , 1986, Anaesthesia.

[18]  A. Reader,et al.  A radioimmunoassay determination of the concentrations of prostaglandins E2 and F2alpha in painful and asymptomatic human dental pulps. , 1985, Journal of endodontics.

[19]  L. Kitahata,et al.  Direct Opioid Application to Peripheral Nerves Does Not Alter Compound Action Potentials , 1985, Anesthesia and analgesia.

[20]  P. Buchan,et al.  Peripheral opioid receptors located on the rat saphenous nerve , 1984, Neuropeptides.

[21]  D. Pashley,et al.  Periodontal ligament injection: evaluation of systemic effects. , 1983, Oral surgery, oral medicine, and oral pathology.

[22]  S. Cooper Models for clinical assessment of oral analgesics. , 1983, The American journal of medicine.

[23]  W. P. Dreyer,et al.  The route of periodontal ligament injection of local anesthetic solution. , 1983, Journal of endodontics.

[24]  R. Walton,et al.  Periodontal ligament injection: distribution of injected solutions. , 1983, Oral surgery, oral medicine, and oral pathology.

[25]  H. McQuay,et al.  Perineural Injection of Morphine Fails to Relieve Postoperative Pain in Humans , 1983, Anesthesia and analgesia.

[26]  C. Hull,et al.  Comparative pharmacokinetics of fentanyl and alfentanil. , 1982, British journal of anaesthesia.

[27]  G. A. Bentley,et al.  EVIDENCE FOR AN ACTION OF MORPHINE AND THE ENKEPHALINS ON SENSORY NERVE ENDINGS IN THE MOUSE PERITONEUM , 1981, British journal of pharmacology.

[28]  L. Iversen,et al.  Multiple opiate receptor sites on primary afferent fibres , 1980, Nature.

[29]  S. Ferreira,et al.  I - Prostaglandin hyperalgesia, a cAMP/Ca2+ dependent process. , 1979, Prostaglandins.

[30]  R. Dionne,et al.  Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars. , 1978, Oral surgery, oral medicine, and oral pathology.

[31]  S. Seltzer,et al.  THE DYNAMICS OF PULP INFLAMMATION: CORRELATIONS BETWEEN DIAGNOSTIC DATA AND ACTUAL HISTOLOGIC FINDINGS IN THE PULP. , 1963, Oral surgery, oral medicine, and oral pathology.

[32]  A. Reader,et al.  The periodontal ligament injection: a comparison of the efficacy in human maxillary and mandibular teeth. , 1988, Journal of endodontics.

[33]  L. Heslet,et al.  Neuronal blockade with morphine. A hypothesis. , 1984, Anaesthesia.

[34]  K. S. Hartman,et al.  The periodontal ligament injection: histological effects on the periodontium in dogs. , 1983, Journal of endodontics.

[35]  S. Ferreira,et al.  Prostaglandin hyperalgesia, V: a peripheral analgesic receptor for opiates. , 1982, Prostaglandins.