Postoperative Pain Management with Oral Methylprednisolone in Symptomatic Patients with a Pulpal Diagnosis of Necrosis: A Prospective Randomized, Double-blind Study

Introduction: The purpose of this prospective randomized, double-blind, placebo-controlled study was to evaluate postoperative pain by using an oral dose regimen of methylprednisolone in symptomatic patients with pulpal necrosis and symptomatic apical periodontitis, a periapical radiolucency, and experiencing preoperative moderate to severe pain. Methods: One hundred twenty-five adult symptomatic patients presenting for emergency endodontic treatment with a pulpal diagnosis of necrosis and symptomatic apical periodontitis, a periapical radiolucency, and experiencing moderate to severe pain participated. All patients received complete endodontic debridement and were randomly divided into 2 groups. In a double-blind manner, the groups received either an oral regimen of methylprednisolone (96 mg immediately after treatment followed by 48 mg each day for 5 consecutive days) or a lactose placebo. All patients received 600 mg ibuprofen and an opioid-containing escape medication to take if needed. Patients completed a 7-day diary to record pain and number of analgesic medications taken each day. Results: Moderate to severe pain was experienced by 40%-50% of the patients on day 1 and 31% of the patients on day 2, with the pain ratings decreasing during the next 7 days. There were no statistically significant differences in pain ratings between the methylprednisolone and placebo groups. Conclusions: When compared with a placebo, the current regimen of oral methylprednisolone did not significantly reduce postoperative pain after complete debridement of symptomatic patients presenting for emergency endodontic treatment with a pulpal diagnosis of necrosis and symptomatic apical periodontitis, periapical radiolucency, and experiencing moderate to severe pain.