American Association of Oral and Maxillofacial Surgeons

White Paper

Opioid Prescribing: Acute and Postoperative Pain Management
Oral and maxillofacial surgeons must demonstrate safe andcompetent opioid prescribing for acute and postoperative
pain in their patients. Responsible prescribing of opioids
must be a priority, including accessing the state’sprescription-drug monitoring program as well as educating
the patient and family about potential risks – and the safe
use, storage and disposal – of opioid analgesics. Because
prescribing protocols evolve over time, practitioners also
should stay informed of the latest public health trends,
including possible alternatives to opioid pain treatment.

• Providers should prescribe non-steroidal
anti-inflammatory drugs (NSAIDs) as first-line
analgesic therapy, unless contraindicated. If NSAIDs
are contraindicated, providers should prescribe
acetaminophen (N-acetyl-p-aminophenol [APAP])
as first-line analgesic therapy.

It is the position of AAOMS that the practitioner-patient
relationship must be upheld, allowing for practitioner
judgment in the management of a patient’s pain –including drug types, dosages and treatment durations.
Pain management decisions should be individualized andonly determined after a careful assessment of the levelof risk to – and condition of – the patient. While oral
and maxillofacial surgeons should ultimately make all
final prescribing decisions, the recommendations in thisAAOMS White Paper are intended to provide direction
and serve as a supportive resource.

• When indicated for acute breakthrough pain, consider
short-acting opioid analgesics. If opioid analgesics areconsidered, start with the lowest possible effective dose
and the shortest duration possible.

Considerations and recommendations for the managementof acute and postoperative pain include the following:• A nonsteroidal anti-inflammatory drug administeredpre-emptively may decrease the severity ofpostoperative pain.
• A perioperative corticosteroid (dexamethasone) may
limit swelling and decrease postoperative discomfort
after third-molar extractions.
• A long-acting local anesthetic (e.g., bupivacaine,etidocaine, liposomal bupivacaine) may delay onset
and severity of postoperative pain.
• The oral and maxillofacial surgeon should avoid starting
treatment with long-acting or extended-release opioidanalgesics.

• NSAIDs and APAP, taken simultaneously, work
synergistically to rival opioids in their analgesic
effect, but dosage levels and times of administration
should be carefully documented to prevent overdosage.

• When prescribing opioids, state law may requireprescribers to access the state prescription drugmonitoring program (PDMP). If there is any suspicionof patient drug misuse, abuse and/or addiction, the OMS
should access the PDMP. To assess for opioid misuseor addiction, use targeted history or validated screening
tools.
• All instructions for patient analgesia and analgesic
prescriptions should be carefully documented.
• When deviating from these prescribing
recommendations – or those required by statelaws or institutions – the oral and maxillofacial
surgeon should document the justification for
doing so.
Oral and maxillofacial surgeons also should:• Address exacerbations of chronic or recurrent
pain conditions with non-opioid analgesics,
non-pharmacological therapies and/or referralto specialists for follow-up, as clinically appropriate.
• Limit the prescriptions of opioid analgesics to patientscurrently taking benzodiazepines and/or other opioids
because of the risk factors for respiratory depression.

PAGE 1 Opioid Prescribing: Acute and Postoperative Pain Management• Inform patients that the recommended maximum daily
dose of acetaminophen should not exceed 3,000 to4,000 mg.
• Counsel patients that the recommended maximum daily
dose of ibuprofen is 3,200 mg.
• Educate patients on the expectations of postoperative
pain management and the anticipated levels of relief.
• Not prescribe acetaminophen with codeine to treat pain
in pediatric patients. For more information, visit theFDA Drug Safety site.
For additional guidance, refer to the CDC Clinical Practice
Guideline for Prescribing Opioids for Pain.
Revised January 2024
© 2024 American Association of Oral and Maxillofacial Surgeons.
No portion of this publication may be used or reproduced without
the express written consent of the American Association of Oraland Maxillofacial Surgeons.

PAGE 2 Opioid Prescribing: Acute and Postoperative Pain Management

White Paper