PITT DENTAL MEDICINE ANNOUNCES
Costello Guidelines and Pledge to Responsible Pain Care Management
The University of Pittsburgh School of Dental Medicine recently announced The Costello Guidelines for Prescribing Pain Medications™ and The Costello Pain Care Pledge™ , a commitment towards responsible pain management for healthcare providers ’ consideration and adoption .
The Costello Pledge is incorporated into student and resident training as part of the Pitt curriculum and is now included in the school ’ s annual White Coat Ceremony . This initiative , announced on Dec . 2 , 2021 , represents a dramatic change in the way that clinicians can prudently manage a patient ’ s pain following a procedure or as part of ongoing treatment .
“ At Pitt Dental Medicine , we are committed to combatting the opioid crisis ,” said Bernard J . Costello , DMD , MD , dean of Pitt ’ s School of Dental Medicine and the author of the Costello Guidelines and the Costello Pledge . “ The Costello Pledge was developed to reinforce our own accountability in prescribing pain medications , and we invite all prescribers throughout the medical and dental community to demonstrate their devotion to these same principles in their own patients ’ care . We believe it ’ s simply a matter of holding ourselves to the highest ethical standards and staying true to our responsibilities as healthcare professionals in the spirit of ‘ first , do no harm .’”
For decades , opioid pain relievers have been routinely prescribed for dental procedures , including the surgical extraction of wisdom teeth – often a teenager ’ s first exposure to opioids . The increased use of opioids contributed to the current epidemic and drug overdose deaths , which has seen a significant increase during the COVID-19 pandemic , according to recent provisional data released by the Centers for Disease Control and Prevention .
The guidelines offer reasonable , yet flexible guidance for all clinicians to prescribe nonnarcotics whenever possible . The protocol is based on evidence that alternative , nonopioid medications work as well or better than opioids for managing pain after dental work , without the side effects of nausea , vomiting , constipation and the potential for misuse . In 2019 , Pitt Dental Medicine became the first dental school in the nation to implement opioid-free pain management guidelines for the vast majority of procedures performed in all of its clinics . Among other factors , the Costello Guidelines take into account the severity , duration , and unique risk considerations when prescribing pain medications for a particular individual following various dental procedures .
“ In its first year of implementation , we achieved a significant reduction ( i . e ., 54.3-percent ) in opioid prescriptions with no deleterious effects for our patients ,” Costello said . “ This achievement is even more impressive since it occurred at the height of the COVID pandemic when telemedicine and medications were virtually the only tools at our disposal . And , these
20 MARCH / APRIL 2022 | PENNSYLVANIA DENTAL JOURNAL