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Uricosuric agents Probenecid is used in the treatment of gout. It is a uricosuric and renal blocking agent that inhibits reabsorption of urates in the tubules of kidney. But increase excretion of uric acid’ the serum urate level is lowered. It induces exacerbations of acute gout. Acute symptoms are controlled by colchicines and therefore the combination is used in chronic gout. Diet L tryopthan an amino acid is main dietary supplement brain and spinal cord serotoninergic neurons are actively in nociceptive receptors as well as in analgesic effect of opiates. Increased activity of serotonin inter neuron is associated with analgesia and enhanced drug potency. Case was reported where pain relief was not possible even after 30 mg of intravenous morphine. But pain is controlled by 4 grams of L tryptophan per day for several weeks. Conclusion Through rational drug-prescribing habits and education of both patients and caregivers, effective regimes can be designed to increase pain control while decreasing untoward drug side effects. A lucid un-derstanding of pharmacology and drug actions as invaluable because knowledge of real or potential drug interactions can assist in design-ing regimes that will be most use full in treating patients with acute or chronic debilitating pain syndromes. Purpose The purpose of this document is to provide evidence-based guidance on prescribing for acute dental pain. This guidance seeks to reduce unnecessary opioid prescribing and assist dentists in selecting the most appropriate, effective, and safest pain medication based on patients’ individual medical status. This document does not consider every medical condition but rather addresses the most common systemic medical conditions that affect acute pain medicine prescribing. This document is intended for general dentists and does not address pain management for the more complex and extensive surgeries performed by oral surgeons. Background and Statistics • OPIOID OVERDOSES - Prescription and non-prescription opioid misuse is a growing problem in the United States, resulting in increasing rates of overdose deaths. Opioid overdoses are highest in the American Indian / Alaska Native (AI/AN) and non-Hispanic white populations1. • CDC GUIDANCE ON ACUTE PAIN MANAGEMENT - In 2016, The Centers for Disease Control and Prevention (CDC) outlined recommendations for management of chronic pain, but guidance on the treatment of acute pain was lacking. However, the CDC did recognize that chronic opioid therapy often stems from the use of opioids for acute pain. It also stated, “Clinicians should prescribe the lowest effective dose of immediate‐release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.” The CDC recommends against prescribing additional day supply “just in case” the patient’s pain lasts longer than the expected duration2. • AMOUNT OF DENTAL OPIOID PRESCRIPTIONS – From 2000-2009, dentists were responsible for 8% of the overall opioid prescriptions in the U.S. (totaling 18 million opioid prescriptions a year) and were second only to primary care physicians as opioid prescribers3. Dentists also prescribed 12.2% of all immediate-release opioids4. In 2012, dentists dropped from 2nd most prevalent prescriber of opioids to the 5th with 6.4% of overall opioid prescriptions. Even with this reduction as compared to other provider categories, dentists still increased their overall opioid prescriptions to 18.5 million5. • UNUSED OPIOIDS FROM DENTAL PRESCRIPTIONS - Over half of the opioids prescribed after dental surgeries are not used by patients6. More than one-third (37.9%) of dental patients at an academic outpatient dental clinic reported some form of nonmedical use of prescription opioids and 6.5% of these respondents reported diverting their medication to others7. Reducing unused medication in the community could significantly impact public health and reduce likelihood of long-term opioid use/misuse2. • 3rd MOLAR EXTRACTION PRESCRIPTIONS - An important dental population exposed to opioids are the 5 million people per year undergoing 3rd molar extraction8. 3rd molar extractions are responsible for approximately 3.5 million young adults being exposed to opioid pain medications each year9. The average age range of patients receiving opioids for 3rd molar extractions is 14-24 years old10,11, with a mean age of 2012,13. Age 20 is also the average age at which people try using an opioid non-medically for the first time. Oral and maxillofacial surgeons in the US reported