ANALGESIC AGENTS AND STRATEGIES IN THE DENTAL PAIN MODEL

Pain following removal of impacted third molar teeth has proven to be a useful clinical model for evaluating oral analgesics. Moreover, as t he underlying pathophysiology becomes elucidated the model serves as a tool for monitoring the relative contributions of different pain even ts, including peripheral and central sensitization. Non-steroidal anti -inflammatory drugs (NSAIDs) demonstrate high potency in this model, r eflecting the large contribution that peripheral prostaglandins may ma ke to the pathophysiology of postoperative pain. However, other analge sic agents, with weak activity against peripheral prostaglandin synthe sis (e.g. paracetamol, opioid analgesics), may also provide pain relie f in the dental pain model. The activity of these agents is dependent on the time and method of administration, and may be related to more c entrally located analgesic activity, or to peripheral actions other th an inhibition of prostaglandin synthesis. In single dose studies it is possible to enhance pain relief by combining analgesic agents of diff erent activities, e.g. ibuprofen 400 mg and codeine 20 mg. Such enhanc ed activity is also demonstrated by higher doses of certain NSAIDs, e. g. ketoprofen 100 mg. This may reflect the existence of complimentary analgesic activities within a single therapeutic agent. As a clinical research tool the dental pain model has several attributes which sugge st that it will continue to be of value in identifying potentially imp roved analgesic strategies for postoperative pain.