{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:42:14Z","timestamp":1792600934195,"version":"4.5.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence guiding postoperative pain management in patients taking prescription or illicit opioids undergoing minor oral surgery is limited. It remains unclear whether standard analgesic protocols for opioid na\u00efve patients provide adequate pain relief in opioid tolerant individuals. This study evaluated whether standard postoperative analgesia achieves adequate pain control in opioid tolerant patients undergoing minor oral surgery with expected mild to moderate pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single centre retrospective study was conducted of patients undergoing minor oral surgical procedures at a public oral surgery service between May 2020 and May 2024. Patients were classified as opioid tolerant if prescribed opioids for longer than one month, receiving methadone therapy, reporting current illicit opioid use, or having a documented history of opioid use disorder. Opioid na\u00efve patients served as controls. Standard postoperative analgesia consisted of paracetamol and non-steroidal anti-inflammatory drugs unless contraindicated. The primary outcome was return with postoperative pain requiring additional opioid analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1,263 patient records met inclusion criteria, including 184 opioid tolerant and 1,079 opioid na\u00efve patients. Opioid tolerant patients were significantly more likely to return with postoperative pain requiring additional opioid analgesia compared with opioid na\u00efve patients (28.8% vs. 2.2%; adjusted OR 24.59, 95% CI: 13.26\u201345.62;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). This association remained consistent across demographic subgroups and extraction types.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current post operative analgesic pathways may not fully address the analgesic requirements of some opioid exposed patients. This study demonstrates that opioid tolerance is associated with an increased risk of return presentation requiring additional opioid analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>Opioid tolerance is associated with an increased risk of inadequate postoperative pain control, highlighting the need for tailored analgesia beyond standard regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-026-07229-4","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:40:08Z","timestamp":1792554008000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative pain outcomes following minor oral surgery in opioid tolerant patients: a retrospective cohort study"],"prefix":"10.1007","volume":"30","author":[{"given":"Adarsh","family":"Gopinath","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-0088","authenticated-orcid":false,"given":"Femi E.","family":"Ayeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"2","key":"7229_CR1","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jpain.2015.12.008","volume":"17","author":"R Chou","year":"2016","unstructured":"Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL (2016) Management of postoperative pain: A clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists\u2019 Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 17(2):131\u2013157","journal-title":"J Pain"},{"key":"7229_CR2","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1016\/j.joms.2017.04.045","volume":"75","author":"A De Best","year":"2017","unstructured":"Best A, De Silva R, Thomson W, Tong D, Cameron C, De Silva H (2017) Efficacy of codeine when added to paracetamol (Acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: A double-blinded randomized control trial. J Oral Maxillofac Surg 75:2063\u20132069","journal-title":"J Oral Maxillofac Surg"},{"key":"7229_CR3","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1213\/ANE.0b013e3181cf9281","volume":"110","author":"CK Ong","year":"2010","unstructured":"Ong CK, Seymour RA, Lirk P, Merry A (2010) Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic re- view of analgesic efficacy for acute postoperative pain. Anesth Analg 110:1170\u20131179","journal-title":"Anesth Analg"},{"issue":"1","key":"7229_CR4","first-page":"9","volume":"80","author":"LJ Macintyre","year":"2020","unstructured":"Macintyre, Roberts LJ, Huxtable CA (2020) Management of opioid-tolerant patients with acute pain: Approaching the challenges. Drugs (New York N Y) 80(1):9\u201321","journal-title":"Drugs (New York N Y)"},{"issue":"5","key":"7229_CR5","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1177\/0310057X1103900505","volume":"39","author":"C Huxtable","year":"2011","unstructured":"Huxtable C, Roberts LJ, Somogyi AA, Macintyre PE (2011) Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care 39(5):804\u2013823","journal-title":"Anaesth Intensive Care"},{"issue":"4","key":"7229_CR6","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/ACO.0000000000000218","volume":"28","author":"S Shah","year":"2015","unstructured":"Shah S, Kapoor S, Durkin B (2015) Analgesic management of acute pain in the opioid tolerant patient. Curr Opin Anesthesiology 28(4):398\u2013402","journal-title":"Curr Opin Anesthesiology"},{"key":"7229_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11916-020-00922-3","volume":"25","author":"K Rajput","year":"2021","unstructured":"Rajput K, Vadivelu N (2021) Acute pain management of chronic pain patients in ambulatory surgery centers. Curr Pain Headache Rep 25:1","journal-title":"Curr Pain Headache Rep"},{"issue":"4","key":"7229_CR8","doi-asserted-by":"publisher","first-page":"25","DOI":"10.2106\/JBJS.JOPA.16.00020","volume":"4","author":"C Sasek","year":"2016","unstructured":"Sasek C (2016) Perioperative pain management in the chronic opioid user. J Orthop Physician Assistants 4(4):25\u201331","journal-title":"J Orthop Physician Assistants"},{"issue":"3","key":"7229_CR9","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.pmn.2007.02.004","volume":"8","author":"A DuPen","year":"2007","unstructured":"DuPen A, Shen D, Ersek M (2007) Mechanisms of opioid induced tolerance and hyperalgesia. Pain Manage Nurs 8(3):113\u2013121","journal-title":"Pain Manage Nurs"},{"issue":"6","key":"7229_CR10","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1177\/0310057X1704500609","volume":"45","author":"S Stark, Kerr","year":"2017","unstructured":"Stark, Kerr S, Stevens J (2017) Prevalence and predictors of persistent post-surgical opioid use: A prospective observational cohort study. Anaesth Intensive Care 45(6):700\u2013706","journal-title":"Anaesth Intensive Care"},{"issue":"6","key":"7229_CR11","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1111\/ans.15882","volume":"90","author":"L Zhao, Peters","year":"2020","unstructured":"Zhao, Peters L, Gelzinnis S, Carroll R, Nolan J, Di Sano S, Pockney P, Smith S (2020) Post-discharge opioid prescribing after laparoscopic appendicectomy and cholecystectomy. ANZ J Surg 90(6):1014\u20131018","journal-title":"ANZ J Surg"},{"issue":"1","key":"7229_CR12","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1177\/0310057X19895019","volume":"48","author":"CC Allen, Kim","year":"2020","unstructured":"Allen, Kim CC, Braat S, Jones K, Winter N, Hucker TR, Chia A, Lang C, Brooks SL, Williams DL (2020) Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study. Anaesth Intensive Care 48(1):36\u201342","journal-title":"Anaesth Intensive Care"},{"issue":"1","key":"7229_CR13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1002\/jppr.1469","volume":"49","author":"SN Kardell, Hilmer","year":"2019","unstructured":"Kardell, Hilmer SN, Crane JA, MacPherson R, Kim TY, Lisa, Gnjidic D (2019) Investigation of opioid prescribing in the postoperative setting among opioid-na\u00efve surgical patients: a 6\u2010month observational study. J Pharm Pract Res 49(1):58\u201361","journal-title":"J Pharm Pract Res"},{"issue":"1","key":"7229_CR14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/1062860619851170","volume":"35","author":"TJ Shechter, Speed","year":"2020","unstructured":"Shechter, Speed TJ, Blume E, Singh S, Williams K, Koch CG, Hanna MN (2020) Addressing the opioid crisis one surgical patient at a time: Outcomes of a novel perioperative pain program. Am J Med Qual 35(1):5\u201315","journal-title":"Am J Med Qual"},{"key":"7229_CR15","first-page":"237","volume":"31","author":"RW Hurley","year":"2006","unstructured":"Hurley RW, Cohen SP, Williams KA et al (2006) The analgesic effects of peri-operative gabapentin on postoperative pain: A meta-analysis. Reg Anesth Pain Med 31:237\u2013247","journal-title":"Reg Anesth Pain Med"},{"issue":"49","key":"7229_CR16","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s11916-019-0783-z","volume":"23","author":"EM Cornett","year":"2019","unstructured":"Cornett EM, Kline RK, Robichaux SL, Green JB, Anyama BC, Gennuso SA, Okereke EC, Kaye AD (2019) Comprehensive perioperative management considerations in patients taking methadone. Curr Pain Headache Rep 23(49):49\u201358","journal-title":"Curr Pain Headache Rep"},{"issue":"12","key":"7229_CR17","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1001\/jamaoto.2017.1773","volume":"143","author":"J Oltman","year":"2017","unstructured":"Oltman J, Militsakh O, D\u2019AgostinoM, Kauffman B, Lindau R, Coughlin A, Lydiatt W, Lydiatt D, Smith R, Panwar A (2017) Multimodal analgesia in outpatient head and neck surgery: A feasibility and safety study. JAMA Otolaryngology\u2013 Head Neck Surg 143(12):1207\u20131212","journal-title":"JAMA Otolaryngology\u2013 Head Neck Surg"},{"issue":"10","key":"7229_CR18","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1177\/000313481908501017","volume":"85","author":"A Truong","year":"2019","unstructured":"Truong A, Mujukian A, Fleshner P, Zaghiyan K (2019) No pain, more gain: Reduced postoperative opioid consumption with a standardized opioid- sparing multimodal analgesia protocol in opioid-tolerant patients undergoing colorectal surgery. Am Surg 85(10):1155\u20131158","journal-title":"Am Surg"},{"issue":"1","key":"7229_CR19","first-page":"93","volume":"7","author":"V Ventafridda","year":"1985","unstructured":"Ventafridda V, Saita L, Ripamonti C, De Conno F (1985) WHO guidelines for the use of analgesics in cancer pain. Int J Tissue React 7(1):93\u201396","journal-title":"Int J Tissue React"},{"key":"7229_CR20","unstructured":"ANZCA (2021) Opioid Dose Equivalence Calculation Table. https:\/\/www.anzca.edu.au\/getattachment\/6892fb13-47fc-446b-a7a2-11cdfe1c9902\/PS01(PM)-(Appendix)-Opioid-Dose-Equivalence-Calculation-Table. Accessed Aug 2022"},{"key":"7229_CR21","unstructured":"Pergolizzi J, Raffa R (2014) The WHO pain ladder: Do we need another step? Pract Pain Manag 2014;14(1):42\u201352"},{"issue":"10","key":"7229_CR22","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1097\/j.pain.0000000000001631","volume":"160","author":"JS Khan","year":"2019","unstructured":"Khan JS, Hah JM, Mackey SC (2019) Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain 160(10):2374\u20132379","journal-title":"Pain"},{"issue":"10","key":"7229_CR23","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1097\/AJP.0000000000000472","volume":"33","author":"D Kim","year":"2017","unstructured":"Kim D, Park J, Karm M-H, Bae H-Y, Lee J-Y, Soo Ahn H, Lee K, Leem JG (2017) Smoking may increase postoperative opioid consumption in patients who underwent distal gastrectomy with gastroduodenostomy for early stomach cancer: A retrospective analysis. Clin J Pain 33(10):905\u2013911","journal-title":"Clin J Pain"}],"container-title":["Clinical Oral Investigations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-026-07229-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00784-026-07229-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-026-07229-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:02:55Z","timestamp":1792598575000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00784-026-07229-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11]]}},"alternative-id":["7229"],"URL":"https:\/\/doi.org\/10.1007\/s00784-026-07229-4","relation":{},"ISSN":["1436-3771"],"issn-type":[{"value":"1436-3771","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"27 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study received the approval of Nepean Blue Mountains Local Health District (NBMLHD) Human Research Ethics Committee (2024APO_037).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"540"}}