Cryotherapy and Topical Minocycline as Adjunctive Measures to Control Pain After Third Molar Surgery: An Exploratory Study

Abstract

Purpose To assess the impact of cryotherapy or topical minocycline on patients’ perceptions of recovery from pain after third molar surgery in an exploratory comparative-effectiveness study. Patients and Methods Subjects aged at least 14 years who were having all 4 third molars removed were enrolled in 3 separate institutional review board–approved studies. Study groups included subjects treated with a passively applied cold wrap for 24 hours postoperatively, subjects treated with topical minocycline during surgery, and subjects enrolled in a nonconcurrent comparison group who had received neither topical minocycline nor directed cryotherapy. Third molar surgery was performed in all cases by trained surgeons using the same protocol. An exact Kruskal-Wallis test was used to compare the distributions of the worst and average pain scores and a Fisher exact test to compare verbal responses from Gracely pain scales among the 3 groups for postsurgical days (PSDs) 1 to 3. Results This study comprised 51 cryotherapy subjects (2005–2009), 63 minocycline subjects (2003–2004), and 92 comparison-group subjects (2002–2006) who were treated at academic centers and in community practices across the United States (N = 206). Demographic descriptors were similar among all groups. For PSDs 1 through 3 (unadjusted), the highest scores for worst pain (6–7 [out of 7] on Likert-type scale) were reported less frequently in each of the study groups than in subjects in the comparison group, although the numbers of subjects reporting the highest scores were few. The distribution of pain outcomes was significantly different among the 3 groups for worst pain and affective words on PSD 1 (P = .04 for both). However, the small number of subjects who reported the highest pain scores precluded adequate multivariate statistical analyses for all outcomes on PSD 1 to 3. Conclusions Data from this exploratory study suggest that adjunctive therapy to decrease postoperative pain—cryotherapy or topical minocycline—might be effective at moderating the patient’s highest pain levels after third molar surgery. The topic should be studied further in a multicenter, prospective, randomized trial.

Microglial Signaling in Chronic Pain with a Special Focus on Caspase 6, p38 MAP Kinase, and Sex Dependence

“…As a microglial inhibitor, minocycline (a tetracycline antibiotic) is approved for use in humans; some clinical trials have been performed showing limited promise for targeting the microglial pathway in the management of orofacial pain (Stavropoulos et al 2006;Gelesko et al 2011). However, propentofylline (a CNS glial modulator) does not decrease pain in postherpetic neuralgia patients (Landry et al 2012).…”

Therapeutic efficacy of cryotherapy on facial swelling, pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review

“…However, the effectiveness of cryotherapy to diminish facial swelling, pain and trismus and improve IQOL after SRM3 has not yet been fully elucidated or assessed specifically in a systematic review. Moreover, the results of previously published studies are inconsistent and there is no consensus in the literature regarding the optimal delivery mode, frequency of application and appropriate duration of each individual treatment sessions as well as total length of treatment time to attain the best outcome of cryotherapy after SRM3 . Therefore, the objective of the present systematic review was to test the hypothesis of no difference in facial swelling, pain, trismus and IQOL after SRM3, with or without post‐operative cryotherapy.…”

“…From a clinical and patient perspective, it would be an advantage if cryotherapy could diminish facial swelling, pain and trismus and improve the immediate quality of life (IQOL) after SRM3. Numerous studies have previously evaluated the influence of cryotherapy on post‐operative sequelae after SRM3 . However, the effectiveness of cryotherapy to diminish facial swelling, pain and trismus and improve IQOL after SRM3 has not yet been fully elucidated or assessed specifically in a systematic review.…”

Pain‐ameliorating effects of minocycline: An emerging treatment modality

“…Interestingly, topical minocycline decreases pain after local administration following dental surgery (Gelesko et al, 2011). These examples clearly illustrate the significant antinociceptive effects of minocycline and the need for further studies in humans to elaborate its analgesic properties fully.…”