Control of pain with patient advice sheets: COPPAS. A randomised control trial of advice, acupressure vs non-steroidal anti-inflammatory drugs (NSAIDs)
Aim: This study investigated whether acupressure resulted in the reduction of pain after orthodontic treatment compared to non-steroidal anti-inflammatory drugs (NSAIDs). The primary objective was to compare pain experience by assessing the effectiveness of advice to use acupressure or NSAIDs in controlling pain by measuring the degree of pain after bonding of brackets to teeth and placement of an initial archwire. For the secondary objectives, pain diaries were used to record the impact of orthodontic treatment and associated discomfort on sleep and diet at intervals ranging from 4hrs to 7 days after placement of initial archwire. Subjects: This was a single centre randomised clinical trial with 36 participants recruited aged between 12-22 years, meeting the following criteria: Inclusion criteria: i) aged 12-25, ii) malocclusion requiring treatment, iii) scheduled to begin orthodontic treatment, iv) require fixed appliances in both arches, v) able to understand and follow advice sheets. Exclusion criteria: i) previous orthodontic treatment, ii) current use of analgesics, iii) contraindications to NSAIDs, iv) previous acupressure experience, v) pregnancy Methods: In the acupressure group the participants were advised to use acupressure point LI4 on the back of the hand to control orthodontic pain. In the NSAID group the subjects were advised to take ibuprofen for orthodontic pain. All subjects were given advice about rescue medication if their pain was not controlled using their current regime. Their responses were collected using VAS scores at time-points ranging from 4hrs, to 7 days. Data analysed using a mixed group factorial analysis of variance (ANOVA). Results and Conclusion: Thirty six patients (69.5% female and 30.5% male) were recruited to the trial. There was no clinically significant difference in the control of orthodontic pain between acupressure and NSAIDs. There was no difference in sleep and diet between the acupressure and NSAIDs group. Acupressure could be recommended as an alternative to NSAIDs use for post bond-up pain for orthodontic patients.
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