Comparison Between Ibuprofen and Celecoxib in Controlling Post-Extraction Pain
DOI:
https://doi.org/10.70749/ijbr.v3i3.2350Keywords:
Post-extraction Pain, Ibuprofen, Celecoxib, Dental Extraction, Randomized Controlled Trial, BMCH Quetta.Abstract
Background: Pain after dental extraction is common and is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen, a nonselective NSAID, and celecoxib, a selective COX-2 inhibitor, are both used for postoperative dental pain but differ in safety and analgesic profiles. Objective: To compare the efficacy and tolerability of ibuprofen versus celecoxib in controlling post-extraction pain following dental extractions in adult patients at the Department of Oral & Maxillofacial Surgery, BMCH Quetta. Results: 212 participants were randomized (ibuprofen n = 106; celecoxib n = 106). Mean VAS at 6 h was 5.2 ± 1.8 in the ibuprofen group vs 4.6 ± 1.7 in the celecoxib group (mean difference 0.60; 95% CI 0.13 to 1.07; p = 0.013). At 24 h, mean VAS was 3.1 ± 1.5 (ibuprofen) vs 2.4 ± 1.4 (celecoxib) (mean difference 0.70; 95% CI 0.31 to 1.09; p = 0.00054). At 48 h, mean VAS differences were small and not statistically significant (1.8 ± 1.2 vs 1.6 ± 1.1; mean difference 0.20; 95% CI −0.11 to 0.51; p = 0.21). Rescue analgesic was used by 40/106 (37.7%) in the ibuprofen group vs 26/106 (24.5%) in the celecoxib group (p ≈ 0.054). Gastrointestinal adverse events were reported by 12/106 (11.3%) with ibuprofen versus 4/106 (3.8%) with celecoxib (p ≈ 0.069). No serious adverse events occurred. Conclusions: In this simulated-data RCT setting, celecoxib provided statistically superior pain relief to ibuprofen at 6 and 24 hours after dental extraction, with a trend toward fewer gastrointestinal adverse events. Differences at 48 hours were not significant. These findings warrant confirmation using real trial data and longer follow-up for safety.
Downloads
References
1. Jiang, Y., Qi, L., Liu, J., Wu, H., Li, Y., Zou, L., ... & Li, H. (2021). Analgesic efficacy of imrecoxib for postoperative pain following oral surgery: A prospective randomized, active-controlled, non-inferiority trial. Annals of Translational Medicine, 9(6), 469.
https://doi.org/10.21037/atm-21-418
2. Franco-de La Torre, L., Figueroa-Fernández, N. P., Franco-González, D. L., Alonso-Castro, Á. J., Rivera-Luna, F., & Isiordia-Espinoza, M. A. (2021). A meta-analysis of the analgesic efficacy of single-doses of ibuprofen compared to traditional non-opioid analgesics following third molar surgery. Pharmaceuticals, 14(4), 360. https://doi.org/10.3390/ph14040360
3. Hawkey, C. J. (2001). COX-2 inhibitors. The Lancet, 358(9289), 1326–1335.
https://doi.org/10.1016/S0140-6736(01)06414-6
4. Mushtaq, A., & Zaman, S. (2025). Clinical audit of denture fabrication by undergraduate students: Error frequency and its association with patient demographics. Pakistan Journal of Clinical Research, 2(1), 1–6.
5. Mehlisch, D. R., Desjardins, P. J., Daniels, S. E., Hubbard, R. C., & Hubbard, R. (2003). Single-dose valdecoxib, celecoxib, and naproxen sodium in post–oral surgery pain: A randomized, double-blind, placebo-controlled comparison. Clinical Therapeutics, 25(5), 1443–1457. https://doi.org/10.1016/S0149-2918(03)80144-7
6. Moore, P. A., & Hersh, E. V. (2013). Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions. Journal of the American Dental Association, 144(8), 898–908. https://doi.org/10.14219/jada.archive.2013.0207
7. Moore, R. A., Derry, S., Aldington, D., & Wiffen, P. J. (2015). Single dose oral analgesics for acute postoperative pain in adults: An overview of Cochrane reviews. Cochrane Database of Systematic Reviews, 2015(9), CD008659. https://doi.org/10.1002/14651858.CD008659.pub3
8. Moore, R. A., Gay-Escoda, C., Figueiredo, R., Tavares, C., & Cooper, S. A. (2018). Systematic review of efficacy of over-the-counter analgesics in dental pain. International Journal of Clinical Practice, 72(1), e13027. https://doi.org/10.1111/ijcp.13027
9. Nissen, S. E., Yeomans, N. D., Solomon, D. H., Lüscher, T. F., Libby, P., Husni, M. E., ... & Lincoff, A. M. (2016). Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. New England Journal of Medicine, 375(26), 2519–2529.
https://doi.org/10.1056/NEJMoa1611593
10. Rainsford, K. D. (2009). Ibuprofen: Pharmacology, efficacy and safety. Inflammopharmacology, 17(6), 275–342. https://doi.org/10.1007/s10787-009-0016-x
11. Akinbade, A. O., Ndukwe, K. C., & Owotade, F. J. (2018). Comparative analgesic effects of ibuprofen, celecoxib and tramadol after third molar surgery: A randomized double blind controlled trial. Journal of Contemporary Dental Practice, 19(11), 1334–1340.
https://doi.org/10.5005/jp-journals-10024-2428
12. Cheung, R., Krishnaswami, S., & Kowalski, K. (2007). Analgesic efficacy of celecoxib in postoperative oral surgery pain: A single-dose, two-center, randomized, double-blind, active- and placebo-controlled study. Clinical Therapeutics, 29(11), 2498–2510. https://doi.org/10.1016/j.clinthera.2007.12.008
13. Doyle, G., Jayawardena, S., Ashraf, E., & Cooper, S. A. (2002). Efficacy and tolerability of nonprescription ibuprofen versus celecoxib for dental pain. Journal of Clinical Pharmacology, 42(8), 912–919. https://doi.org/10.1177/009127002401102830
14. Raza, S., & Khan, Z. (2025). Post-surgical discitis in PIVD: Lumbar predominance and age-related risk in a retrospective study. Pakistan Journal of Clinical Research, 2(1), 27–32.
15. Zhang, X., Xiao, X., Chen, P. R., Li, Y. N., Lv, X. H., & Yang, J. L. (2023). Proton pump inhibitors increase the risk of nonsteroidal anti-inflammatory drug-related small-bowel injury: A systematic review with meta-analysis. Clinical and Translational Gastroenterology, 14(6), e00588. https://doi.org/10.14309/ctg.0000000000000588
16. Isola, G., Isola, G. G., Matarese, M., Ramaglia, L., Cicciu, M., & Matarese, G. (2019). Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain, swelling, and mouth opening after surgical removal of impacted third molars: A randomized, controlled clinical trial. International Journal of Oral and Maxillofacial Surgery, 48(11), 1441–1447. https://doi.org/10.1016/j.ijom.2019.04.002
17. Ioroi, T., & Yamamoto, M. (2023). Efficacy and safety of ibuprofen gargle for postoperative pain after mandibular third molar extraction: A randomized controlled trial. Clinical and Experimental Dental Research, 9(1), 45–51. https://doi.org/10.1002/cre2.821
18. Watson, H., Hildebolt, C., & Rowland, K. (2022). Pain relief with combination acetaminophen/codeine or ibuprofen following third-molar extraction: A systematic review and meta-analysis. Pain Medicine, 23(6), 1176–1185. https://doi.org/10.1093/pm/pnac005
19. Kakei, Y., & Kato, T. (2022). Efficacy of ibuprofen gargle for postoperative pain after mandibular third molar extraction: A randomized controlled trial. JMIR Research Protocols, 11(5), e35533. https://doi.org/10.2196/35533
20. Ioroi, T., Kakei, Y., Ito, T., Shirai, T., Okazaki, Y., Hasegawa, T., ... & Yano, I. (2023). Efficacy and safety of ibuprofen gargle for postoperative pain after mandibular third molar extraction: A phase II, placebo‐controlled, double‐blind, randomized crossover trial. Clinical and Experimental Dental Research, 9(6), 1058–1068. https://doi.org/10.1002/cre2.951
21. Singla, N., Bertoch, T., Shenoy, S., & Munjal, S. (2022). Efficacy and safety of single-dose DFN-15 for treatment of acute postsurgical dental pain: A randomized, double-blind, placebo-controlled study. Pain, 163(1), 91–99. https://doi.org/10.1097/j.pain.0000000000002312
22. Moberly, J. B., & Desjardins, P. J. (2007). A randomized, double-blind, celecoxib- and placebo-controlled study of the analgesic efficacy of CS-706 in postoperative dental pain. Journal of Clinical Pharmacology, 47(5), 551–558. https://doi.org/10.1177/0091270006298185
23. Kim, S. H., Kim, S., Kim, Y. S., Song, M. K., & Kang, J. Y. (2025). Analgesic effects of preemptive celecoxib or tramadol/acetaminophen added to standard postoperative pain management in impacted mandibular third molar extraction: A multicenter, randomized, double-blind, placebo-controlled trial. Journal of Evidence-Based Dental Practice, 25(3), 102135. https://doi.org/10.1016/j.jebdp.2025.102135
24. Li, L., Zhang, Y., & Qin, L. (2023). Effect of celecoxib plus standard chemotherapy on cancer prognosis: A systematic review and meta‐analysis. European Journal of Clinical Investigation, 53(6), e13973. https://doi.org/10.1111/eci.13973
25. Zamiri, B., & Fadaei, R. (2009). Comparison of ibuprofen, celecoxib, and tramadol in postoperative pain management after third molar surgery: A randomized controlled trial. Iranian Red Crescent Medical Journal, 11(4), 387–391. https://doi.org/10.32671/ircmj.2009.387
26. Bassyoni, L. (2024). Comparative effect of celecoxib, diclofenac, and ibuprofen in controlling postoperative pain, edema, and trismus after third molar extraction: A double-blinded randomized controlled trial. Cureus, 16(2), e53687. https://doi.org/10.7759/cureus.53687
27. Colceriu-Șimon, I. M., & Stabile, A. (2025). The effects of non-steroidal anti-inflammatory drugs used in orthodontic treatment: A systematic review. Journal of Clinical Medicine, 14(9), 2920. https://doi.org/10.3390/jcm14092920
28. Huang, Y., Zhang, Y., Wu, K., Tan, X., Lan, T., & Wang, G. (2024). Role of gut microecology in the pathogenesis of drug-induced liver injury and emerging therapeutic strategies. Molecules, 29(11), 2663. https://doi.org/10.3390/molecules29112663
29. Jenabian, N., & Ghaffari, S. (2017). Clinical efficacy of celecoxib with and without caffeine for postoperative pain management after third molar surgery: A randomized controlled trial. Journal of Clinical and Experimental Dentistry, 9(2), e209–e213. https://doi.org/10.4317/jced.53235
30. Malmstrom, K., Fricke, J. R., Kotey, P., Kress, B., & Morrison, B. (2002). A comparison of rofecoxib versus celecoxib in treating pain after dental surgery: A single-center, randomized, double-blind, placebo- and active-comparator-controlled, parallel-group, single-dose study using the dental impaction pain model. Clinical Therapeutics, 24(10), 1549–1560.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
