Association of genetic polymorphisms with response to preoperative NSAIDs in endodontic postoperative pain: a randomized double-blind placebo-controlled clinical trial.

To evaluate the effects of single nucleotide polymorphisms in the CYP2C8, CYP2C9, and UGT2B7 genes on postoperative pain intensity and analgesic response in patients receiving preoperative ibuprofen or diclofenac before endodontic treatment. This randomized, double-blind, placebo-controlled clinical trial included 191 patients who required endodontic treatment. Patients were randomized to receive ibuprofen 600 mg (n = 61), diclofenac 100 mg (n = 65), or placebo (n = 65). The medications were administered preoperatively, 30 min before the endodontic treatment. Postoperative pain intensity together with analgesic consumption as the primary clinical outcomes was assessed using a visual analog scale at 6, 12, and 24 h and on days 2, 3, 5, and 7 postoperatively and analgesic consumption was recorded during the follow-up period. Genetic polymorphisms of CYP2C8, CYP2C9, and UGT2B7 were analyzed in all participants. The relationship between genotypes and postoperative pain scores and analgesic response was statistically evaluated. There were no statistically significant differences among the drug groups in terms of postoperative pain levels. However, in the diclofenac group, the CYP2C8 rs10509681 polymorphism was associated with significantly higher postoperative pain scores at 24 h and on day 2. These findings provide preliminary evidence that genetic variation in CYP2C8 may influence the analgesic response to diclofenac following endodontic treatment. However, these exploratory findings require confirmation in larger, independent studies before their clinical relevance can be established.