Table 1. Summary of pain management strategies in endodontics: behavioral, pharmacological, and anesthetic approaches.

NSAIDs, nonsteroidal anti-inflammatory drugs

Aspect	Details
Behavioral management	Managing patient anxiety and expectations through environmental adjustments, effective communication, distraction methods, and rapport-building. High dental fear often develops in early childhood.
Pharmacological management
Nonopioid analgesics	Include acetaminophen. Used for pain management in various dental conditions
Opioid analgesics	Such as tramadol and codeine. Reserved for severe cases with careful consideration due to the potential for addiction and adverse effects
NSAIDs	Include ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen. Effective for relieving post-endodontic pain. Diclofenac sodium is particularly used for pain and swelling postoperatively
Corticosteroids	Known for their anti-inflammatory and immune-suppressive effects. Beneficial for managing endodontic pain
Trypsin-chymotrypsin	Used to reduce postoperative swelling and manage severe pain
Opioids/narcotic analgesics	Reserved for severe cases where nonnarcotic analgesics are insufficient
Prophylactic antibiotics	Used to manage postoperative endodontic pain, especially when NSAIDs are contraindicated
Analgesic and antibiotic combination	Local application of antibiotics within the root canal system can be effective
Anesthesia	Various methods explored to enhance clinical success in patients with symptomatic irreversible pulpitis and pain management
Premedication	Use of analgesic drugs or supplementary analgesic injections before treatment to enhance anesthetic efficacy
Valacyclovir	Used as an adjunct for treating acute apical abscesses, effective in combination with amoxicillin for pain suppression