Possible Risk of Side Effect in Pharmacotherapy for Non-odontogenic Pain

Abstract

Purpose: Pharmacotherapy for non-odontogenic pain may result in side effects. The purpose of this study was to investigate the side effects of pharmacotherapy for non-odontogenic pain retrospectively and to identify drugs that are at risk of causing side effects.
Methods: The patients’ backgrounds, use of medications, and side effects were extracted from their medical records at the Orofacial Pain Relief Center, Kanagawa Dental University Hospital from November 2018 to March 2020. Logistic regression analysis was performed, with the presence or absence of side effects at below the initial dose as the dependent variable. The independent variables were use of pain medications （amitriptyline hydrochloride, carbamazepine, Ca^2＋ channel α2δ ligands, tramadol hydrochloride）. Model performance was assessed with the Model Chi-square test, the Hosmer-Lemeshow test, Nagelkerke’s R² explained variance, and percentage of correct classifications. Bootstrapping techniques were used to internally validate our model.
Results: Of 123 patients, side effects occurred in 30 patients （24.4％）. A higher risk of side effects in pharmacotherapy for non-odontogenic pain included the use of Ca^2＋ channel α2δ ligand （p＝0.001, odds ratio （OR）: 5.61, 95％ confidence interval （CI）: 2.01-15.7）, and the use of carbamazepine （p＝0.022, OR: 4.02, 95% CI: 1.22-13.3）.
Conclusions: These results suggest that Ca^2＋ channel α2δ ligands （such as pregabalin and myrogabalin besylate） and carbamazepine may have a high risk of developing side effects even at initial doses below those listed in the package insert.