Pain Management Between Endodontic Treatment Sessions: Tramadol, Naproxen, or Novafen?

Objective: Pain management during the time between treatment sessions has always been of great value in endodontic treatment. A practical way is prescribing a combination of analgesic drugs, each with a lower dose to increase their effectiveness and reduce the side effects. Our objective was to compare the effects of oral prescription of Tramadol (a centrally acting opoid analgesic drug), Naproxen (an NSAID which blocks the cyclo-oxigenase pathway and thereby inhibits the release of prostaglandins), and Novafen (a combined analgesic drug comprised of Paracetamol, Ibuprofen, and Caffeine) on pain management between endodontic treatment sessions. Methods: 100 patients (no systemic medical complications, vital incisor or premolar with irreversible pulpitis) were randomly driven into 4 groups (3 experimental and one placebo, n=25/gp, asked to fill-out three questionnaires evaluating the amount of pain (pain scale ruler: modified Visual Analogue Scale [VAS]) on a scale of 0 to 9 (0: no pain, 1-3: mild, 4-6: moderate, 6-9: severe) before, 6, and 12 hours after the first treatment session respectively, received a single dose of either Tramadol (Tramadol hydro-chloride 100mg), Novafen (Cap. Novafen Caffeine 40mg, Ibuprofen 200mg, Paracetamol 325mg-Brown & Bruk-England), or Naproxen (Tab. Naproxen 500 mg-Pars Darou-Iran) in each experimental group and an empty capsule in the placebo group after the first treatment session, and then statistically analyzed (repetitive variance analysis). Results: The pain intensity was less in all the experimental groups than in the placebo group (p<0.05) and there was no significant difference between the effects of Novafen and Naproxen (p>0.05). Tramadol was significantly less effective than Naproxen and Novafen (p<0.05) (fig.1). Conclusion: Prescription of Naproxen or Novafen proved to be effective in pain management between treatment sessions but it was not so for Tramadol.