Effectiveness and Safety of Pretreatment Analgesics and Anti-Inflammatory Drugs in Endodontic Pain Management: Overview of Systematic Reviews.

BACKGROUND: Postoperative pain in endodontic treatment remains a significant challenge and concern for specialists. Despite advancements in treatment techniques, reports of postoperative pain due to trauma to the periapical tissues persist. The pretreatment anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs [NSAIDs] and corticosteroids) and analgesic drugs (opioids and nonopioids) are a pharmacotherapeutic strategy employed for pain relief and inflammation control in endodontics. OBJECTIVE: This overview of systematic reviews of randomized controlled trials (RCTs) synthesized the available evidence on the effectiveness and safety of pretreatment anti-inflammatory and analgesic drugs in pain management for patients undergoing endodontic treatment. METHODS: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and assessed the methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. RESULTS: Fourteen systematic reviews that met the eligibility criteria were included, published between 2016 and 2022, involving between 3 and 27 primary studies that addressed pretreatment use of drugs. Six systematic reviews conducted meta-analyses and found that the pretreatment oral or parenteral corticosteroids reduced postoperative pain, compared with placebo, for 6, 12, and 24 h after nonsurgical endodontic treatment. NSAID systematic reviews have presented many conflicting results. Most reviews were of critically low quality, and data on adverse effects were poorly reported. CONCLUSION: Pretreatment corticosteroids appeared to be associated with more consistent reductions in postoperative pain among patients undergoing endodontic treatment. However, confidence in these findings is limited by substantial heterogeneity, the critically low methodological quality of most reviews, and poor reporting of adverse effects. Further high-quality RCTs are needed.