The Effects of Preemptive Multimodal Analgesic on Endodontic Pain Following Root Canal Therapy.

The Effects of Preemptive Multimodal Analgesic on Endodontic Pain.

A clinical trial comparing preemptive multimodal analgesics with placebo in the management of immediate and chronic post-endodontic pain. The study utilizes statistical methods such as chi-squared, T-tests, and regression analysis, accounting for multiple outcomes with the Bonferroni adjustment. Duloxetine hydrochloride and pregabalin, both available in Bangladesh, are evaluated as experimental drugs, while placebos are used to assess psychological effects on pain. All participants receive standard interventional treatments, with acetaminophen provided as needed, and ethical considerations are addressed according to international guidelines.

Study Overview

• Status: Recruiting
• Conditions: Post Endodontic Pain; Mechanical Detection Threshold; Mechanical Pain Threshold; Mechanical Pain Sensitivity
• Intervention / Treatment: Drug: Pregabalin- Acetaminophen; Drug: Duloxetine- Acetaminophen

• Study Type: Interventional
• Enrollment (Estimated): 280
• Phase: Early Phase 1

Contacts and Locations

• Study Contact: Name: Prof.Dr. Md. Abu Saeed Ibn Harun, MS; Phone Number: 8801711157586; Email: dr.abusaeed@cidch.edu.bd

Study Locations

• Bangladesh
  • Chattogram
    • Chittagong, Chattogram, Bangladesh, 4212
      • Recruiting
      • Professor. Dr. Md. Abu Saeed Ibn Harun
      • Contact: Prof. Dr. Md. Abu Saeed Ibn Harun, MS; Phone Number: 8801711157586; Email: dr.abusaeed@cidch.edu.bd
      • Contact: Mohammad Kamrul Islam, FCPS; Phone Number: 8801818247435; Email: dr.kamrul11@gmail.com
      • Sub-Investigator: Suparna Das, BDs

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Patient's aged 18 years more.
2. ASA physical status I-II.
3. Patient with the complain of pain originated from teeth and surrounding structure.
4. Preoperative pain severity is moderate to severe.
5. Patient can be able to make communication about their pain.
6. Patients give consent to attain this research.
7. Patients have others concomitant chronic pain.
8. Patients who will have non-surgical endodontic treatment.
9. Patients who will have non-surgical endodontic retreatment.
10. Patients who will have surgical endodontic treatment.

Exclusion Criteria:

1. Patient would not like to attain in research.
2. Patients have any medical condition those are contra indication for study drug.
3. ASA physical status III, IV, V.
4. Patient already under treated any anti convulsent drug.
5. Patient participant in other clinical trials.
6. Lack of motivation or poor adharence to study protocols.
7. Patient with Pregnancy
8. Severe organ dysfunction
9. Patient have Hepatitis B, and other cross infection disease like (HIV)
10. Uncontrolled comorbidities that patient do not fit for endodontic treatment.
11. Severe cognitive impaired patients.
12. History of certain cancers or severe hematological issues.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Multimodal Analgesia; Preemptive Multi modal analgesic drug: Experimental group will be divided into 2 subgroups according to use of drug. A. Pregabalin-acetaminophen. B. Duloxetine-Acetaminophen Pregabalin-acetaminophen: Before a half-hour endodontic treatment, patients in this group will receive a single dosage of 50 mg pregabalin and 500 mg acetaminophen. If necessary, acetaminophen dosages of 500 mg will be administered three times a day. Duloxetine-Acetaminophen: Prior to a half-hour endodontic treatment, patients in this group will receive a single dosage of 500 mg of acetaminophen and 30 mg of Duloxetine. If necessary, acetaminophen dosages of 500 mg will be administered three times a day.	Drug: Pregabalin- Acetaminophen; Preemptive Multi modal analgesic drug: Experimental group will be divided into 2 subgroups according to use of drug. A. Pregabalin-acetaminophen. B. Duloxetine-Acetaminophen Pregabalin-acetaminophen: Before a half-hour endodontic treatment, patients in this group will receive a single dosage of 50 mg pregabalin and 500 mg acetaminophen. If necessary, acetaminophen dosages of 500 mg will be administered three times a day.; Drug: Duloxetine- Acetaminophen; Duloxetine-Acetaminophen: Prior to a half-hour endodontic treatment, patients in this group will receive a single dosage of 500 mg of acetaminophen and 30 mg of Duloxetine. If necessary, acetaminophen dosages of 500 mg will be administered three times a day.
Placebo Comparator: Control; Placebo: Patient in this group will receive placebo drug before half an hour of operating procedure. If necessary, acetaminophen dosages of 500 mg will be administered three times a day and noted	Drug: Pregabalin- Acetaminophen; Preemptive Multi modal analgesic drug: Experimental group will be divided into 2 subgroups according to use of drug. A. Pregabalin-acetaminophen. B. Duloxetine-Acetaminophen Pregabalin-acetaminophen: Before a half-hour endodontic treatment, patients in this group will receive a single dosage of 50 mg pregabalin and 500 mg acetaminophen. If necessary, acetaminophen dosages of 500 mg will be administered three times a day.; Drug: Duloxetine- Acetaminophen; Duloxetine-Acetaminophen: Prior to a half-hour endodontic treatment, patients in this group will receive a single dosage of 500 mg of acetaminophen and 30 mg of Duloxetine. If necessary, acetaminophen dosages of 500 mg will be administered three times a day.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effects of Preemptive multimodal analgesia on post endodontic pain	Primary Pain during endodontic treatment and the effectiveness of intervention will be evaluated at 6, 12, 24, 48, 72, and hourly intervals after the endodontic procedure. Treatment-related anaesthetic efficacy will be assessed using the VAS (Visual Analogue Scale; numerical value 0-10). During endodontic treatment, the level of pain will decide how effective the anesthetic is. The patient will be asked to rate the analgesic effects on a VAS (Visual Analogue Scale) scale by providing a numerical number 0-10. '0" are indicated no pain, 1-3= mild pain, 4-6= moderate pain, 7-10= sever pain.	6, 12, 24, 48, 72 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mechanical Detection Threshold	Mechanical Detection Threshold: A standardized set of modified von Frey hairs (Opti-hair2-Set, Marstock Nervtest, Germany) that exert stresses upon bending between 0.25 and 512 mN graded by a factor of 2 (1-2 s contact time) were used to determine the mechanical detection threshold (MDT). With a rounded tip and 0.5 mm in diameter, the von Frey hairs' contact area with the skin was consistent in size and shape to prevent sharp edges that could aid in nociceptor activation. Five threshold determinations with a sequence of increasing and decreasing stimulus intensities were made using the "method of limits." The geometric mean of these five series served as the final threshold.	baseline, 72 hours
Mechanical Pain Threshold	Mechanical Pain Threshold: A set of seven pin-prick mechanical stimulators with preset stimulus intensities (flat contact area of 0.2 mm diameter) that applied forces of 8, 16, 32, 64, 128, 256, and 512 mN were used to test the mechanical pain threshold (MPT). These stimuli were custom-made and weighted. Until the first perception of sharpness was attained, the stimulators were applied in ascending order at a pace of two seconds on, two seconds off. The geometric mean of five sequences of rising and descending stimuli served as the final threshold. The purpose of this test was to identify pinprick hypoalgesia. Before initiation of endodontic treatment, the patient has to take drug that's are supplied in enveloped.	baseline, 72 hours
Mechanical Pain Sensitivity	Mechanical Pain Sensitivity will test using the same weighted pinprick stimuli as for mechanical pain threshold. To obtain a stimulus- response- function, these seven pinprick stimuli will apply in a balanced order, five times each, and patient will ask to give a pain rating for each stimulus on a 0-10 VAS scale ( '0' indicate no pain; 10 indicate most intense pain imaginable.	baseline, 72 hours

Collaborators and Investigators

• Sponsor: Chattogram International Dental College

Publications and helpful links

General Publications

• Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol. 2008;59:565-90. doi: 10.1146/annurev.psych.59.113006.095941.
• Anibal Diogenes, Michael A. Henry. Pain Pathways and Mechanisms of the Pulpodentin Complex. Chapter 8; Seltzer and Bender's Dental Pulp. 2nd edition. Quintessence Publishing Co Inc;2012.
• Jang YE, Kim Y, Kim BS. Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study. J Endod. 2021 May;47(5):770-778.e1. doi: 10.1016/j.joen.2021.01.004. Epub 2021 Jan 29.
• Alelyani AA, Azar PS, Khan AA, Chrepa V, Diogenes A. Quantitative Assessment of Mechanical Allodynia and Central Sensitization in Endodontic Patients. J Endod. 2020 Dec;46(12):1841-1848. doi: 10.1016/j.joen.2020.09.006. Epub 2020 Sep 15.
• Wiech K, Ploner M, Tracey I. Neurocognitive aspects of pain perception. Trends Cogn Sci. 2008 Aug;12(8):306-13. doi: 10.1016/j.tics.2008.05.005. Epub 2008 Jul 5.
• Md. Abu Saeed Ibn Harun et al. The dimension and severity of orofacial pain in patients with current and chronic odontogenic pain. M Dent J 2021; 41(3): 235-244.
• Woolf CJ. Windup and central sensitization are not equivalent. Pain. 1996 Aug;66(2-3):105-8. No abstract available.
• Md. Abu Saeed Ibn Harun et al. Endogenous Pain modulation of Irreversible Pulpitis and Persistent Endodontic Pain. Chattagram International Dental College Journal 2019; 2(1):9-13.
• O'Keefe EM. Pain in endodontic therapy: preliminary study. J Endod. 1976 Oct;2(10):315-9. doi: 10.1016/S0099-2399(76)80047-7. No abstract available.
• Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, Lund JN, Williams JP. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev. 2021 Jun 14;6(6):CD012978. doi: 10.1002/14651858.CD012978.pub2.
• Ince B, Ercan E, Dalli M, Dulgergil CT, Zorba YO, Colak H. Incidence of postoperative pain after single- and multi-visit endodontic treatment in teeth with vital and non-vital pulp. Eur J Dent. 2009 Oct;3(4):273-9.
• Al-Nahlawi T, Alabdullah A, Othman A, Sukkar R, Doumani M. Postendodontic pain in asymptomatic necrotic teeth prepared with different rotary instrumentation techniques. J Family Med Prim Care. 2020 Jul 30;9(7):3474-3479. doi: 10.4103/jfmpc.jfmpc_342_20. eCollection 2020 Jul.
• Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod. 2010 Feb;36(2):224-30. doi: 10.1016/j.joen.2009.11.007.
• Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontic procedures. J Endod. 2009 Jul;35(7):958-61. doi: 10.1016/j.joen.2009.04.017.
• Hargreaves KM, BermanLH, Cohen S. Cohen's Pathways of the Pulp. 11th ed. Amsterdam, Netherlands: Elsevier; 2015.
• Santos-Puerta N, Penacoba-Puente C. Pain and Avoidance during and after Endodontic Therapy: The Role of Pain Anticipation and Self-Efficacy. Int J Environ Res Public Health. 2022 Jan 27;19(3):1399. doi: 10.3390/ijerph19031399.
• Smith EA, Marshall JG, Selph SS, Barker DR, Sedgley CM. Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis. J Endod. 2017 Jan;43(1):7-15. doi: 10.1016/j.joen.2016.09.010. Epub 2016 Dec 6.
• Suneelkumar C, Subha A, Gogala D. Effect of Preoperative Corticosteroids in Patients with Symptomatic Pulpitis on Postoperative Pain after Single-visit Root Canal Treatment: A Systematic Review and Meta-analysis. J Endod. 2018 Sep;44(9):1347-1354. doi: 10.1016/j.joen.2018.05.015. Epub 2018 Jul 24.
• Zanjir M, Sgro A, Lighvan NL, Yarascavitch C, Shah PS, da Costa BR, Azarpazhooh A. Efficacy and Safety of Postoperative Medications in Reducing Pain after Nonsurgical Endodontic Treatment: A Systematic Review and Network Meta-analysis. J Endod. 2020 Oct;46(10):1387-1402.e4. doi: 10.1016/j.joen.2020.07.002. Epub 2020 Jul 12.
• Mazaleuskaya LL, Theken KN, Gong L, Thorn CF, FitzGerald GA, Altman RB, Klein TE. PharmGKB summary: ibuprofen pathways. Pharmacogenet Genomics. 2015 Feb;25(2):96-106. doi: 10.1097/FPC.0000000000000113. No abstract available.
• Compound Summery Acetaminophen. National Library of Medicine. Seen 2023. www.pubchem.ncbi.nlm.nih.gov.
• Park SJ, Zhang S, Chiang CY, Hu JW, Dostrovsky JO, Sessle BJ. Central sensitization induced in thalamic nociceptive neurons by tooth pulp stimulation is dependent on the functional integrity of trigeminal brainstem subnucleus caudalis but not subnucleus oralis. Brain Res. 2006 Sep 27;1112(1):134-45. doi: 10.1016/j.brainres.2006.06.115. Epub 2006 Aug 22.
• 37. Harun, A. S. I. harun, Hossain, . A., Jabber, S. and Hasan, H. . (2021) "The dimension and severity of orofacial pain in patients with current and chronic odontogenic pain", Mahidol Dental Journal. Bangkok, Thailand, 41(3), pp. 235-244. available at: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/251124 (accessed: 3 June 2025).

Study record dates

Study Major Dates

• Study Start (Estimated): February 6, 2026
• Primary Completion (Estimated): March 30, 2027
• Study Completion (Estimated): April 30, 2027

Study Registration Dates

• First Submitted: January 26, 2026
• First Submitted That Met QC Criteria: February 9, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): February 11, 2026
• Last Update Submitted That Met QC Criteria: February 9, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: post endodontic pain; Multimodal Analgesia; Root canal Therapy; Dynamic sensory test
• Other Study ID Numbers: ERC-BBS/2025/0015-44/2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No