Volume 1 Issue S1 - 2015
What Shall We Consider When We Plan For An Invasive Intervention?
Anders Öster1* and Ingalill Morén Hybbinette2
1Specialist in Dentistry (Oral physiology) with a focus on chronic facial pain. Mössebergsvägen, Sweden
2Specialized in family and community medicine, occupational health and rehabilitation medicine, Sweden
*Corresponding Author: Anders Öster Specialist in Dentistry (Oral physiology) with a focus on chronic facial pain. Mössebergsvägen, 29 S-16743 Bromma, Sweden.
Received: December 11, 2015; Published: December 23, 2015
Citation: Anders Öster and Ingalill Morén Hybbinette. “What Shall We Consider When We Plan For An Invasive Intervention?” EC Dental Science 1.S1 (2015): S5-S7.
We have recently got, in Sweden, a new law on patient safety. The main idea is that the law will help to provide better patient safety by that we, in health care ,will be better able to pay attention to, investigate and resolve treating risks and be able to evaluate anamnestic data that could be the reason why the patient seeking our assistance [1].
Media focuses more or less objectively on information about suspicious injuries after surgical procedures in health care [2]. We professionals know that any invasive interference is a potential risk for complications. Don´t forget that all endodontic interventions are invasive. Primus non nocere-not to harm a patient is a beacon of health care.
Already in the early 1990s studies were published which described the post-operative pain following repeated surgical dental procedures [3]. Today world-leading research is under way in respect of consisting post-operative orofacial pain in Malmö Dental College under the direction of Prof. Thomas List [4]. The terms relevant to these kind of postoperative consisting pains is Atypical Odontalgi (AO). Patients with AO have clear signs of peripheral neuropathy and the discomfort starts always with or operative dental procedures or other trauma.
There are well-founded reports in pain scientific literature stating figures up to 40% development of general prolonged pain after trauma and surgery [5,6].
Area-our experience
The authors have for many years worked in a multimodal orofacial pain unit where they encountered patients with persistent facial pain, often post-operative. Patients with post-surgical facial pain with long duration exhibits the same multisymtomatic picture that patients with other chronic physical pain.
We got, not rarely, referrals from general practitioners and colleges in surgery expressing their frustration that the procedures they performed, with the best intentions, does not lead to a good after process with regard to pain management and trouble-free healing.
Disappointed patients had not been pain relieved, but rather described an escalated pain with more troublesome symptoms in the form of a series of autonomic symptoms as signs of malaise. Unfortunately, it appeared that some of these patients had their pain as a direct follow by healthcare shortcomings [7].
Have we engaged in medicine and dentistry too limited knowledge regarding the risk of prolonged postoperative pain?
Knowledge of the interaction between inherited and environmental factors for developing illness and disease (epigenetics) today is great. (The integrative medicine (within the framework of the PNEI psykoneuroendokrinoimmunologi- a term from stress physiology) [8-10] has paved the way for greater understanding of and pathways to possibilities to prevent iatrogenic post-operative prolonged pain.
PNEI can be seen as a model of a human body that in the ideal state is in balance. (P) stands for mental (N) for neuronal (E) endocrine and (I) immunological processes in co-operation.
If we, for a long time, are subjected to an adverse impact load (stress) this balance will be tilted. This leads to autonomic dysfunction that manifests itself as malaise. Immunological surcharge affects the sensitivity of nervous system, from peripheral to which we term central sensitization [11,12]. The direct link between the immune system and the nervous system [13] may explain the pain problems that may be prolonged after invasive measures. The escalated pain following the invasive procedure is in most cases originating in a previously aroused nervous system [14]. The communication between the brain and the immune system dynamically modulate pain has in this manner physiological and pathological implications [15-17]. Everythingrelates to reduced healing ability.
Prolonged stress development, due to psychosocial stress or somatic stress as a result of pain, can lead to both peripheral and central sensitization to become developed as a dysfunction of the autonomic nervous system. A human/patient with chronic life stress has an irritated nervous system, which can predispose to pain problems after operational procedures. Several different factors can interact and provide extended post-operative pain problems.
How should we then make preoperative positions?
If you as dental therapists feel hesitant to perform an invasive odontological surgery due to a vague indication for surgery but have an anxious patient, is an extended anamnestic recording important to do. When the patient’s medical history contains much pain problems of different location, illness without clear medical diagnoses or psychosocial stress, an assessment of a general practitioner or rehabilitation physicians with a broad holistic approach may be needed. Cooperation between dentist and physician with broad general medical skills can give help to choose the right treatment for the right patient. Sometimes care for more multi-professional character; both the physical therapist and the psychological therapist may be needed [18].
The importance of all-encompassing anamneses cannot be sufficiently accentuated. The patient at the risk of escalation of pain as a result of further intervention should be identified and treated on the basis of the holistic approach. Then we can save the patient great suffering and bid society great savings.
Finally: Quality in medicine means: Doing the right thing at the right opportunity on the right person. That means sometimes doing nothing!
Conflict of Interest
No conflict of interest exists.
  1. The leader.  “New law”. Better security Medical Journal 108.3 (2011).
  2. Kehlet H., et al. “Persistent postsurgical pain: risk factors and prevention”. The Lancet 367.9522 (2006): 1618-1625.
  3. Marbach JJ. ”Ice phantom tooth pain a deafferentation (neuropathic) syndrome?” Oral Surgery Oral Medicine and Oral Pathology 75 (1993): 95-105.
  4. List T., et al. ”Clinical findings and psychosocial factors in patients with atypical odontalgia: a case-control study”. Journal of Orofacial Pain 21.2 (2007): 89-98.
  5. IASP. ”Pain Clinic Updates Chronic Pain after Surgery”. XIX.1 (2011).
  6. Taylor KS., et al. ”Chronic pain and sensorimotor deficits following peripheral nerve injury”. Pain 151.3 (2010): 582-591.
  7. Anders Wade Ylva and Lidén Staffan Arnér. ”Most of all chronic pain a result of failures of care”. Swedish Medical Journal 102.10 (2005).
  8. C Richard Chapman., et al. ”Pain and Stress in a Systems Perspective: Reciprocal Neural, Endocrine, and Immune Interaction”. The Journal of Pain 9.2 (2008): 122-145.
  9. Lutgendorf SK., et al. ”Psychoneuroimmunology and health psychology: An integrative model”. Brain, Behavior, and Immunity 17.4 (2003): 225-232.
  10. Michael R Irwin. ”Human psychoneuroimmunology: 20 Years of discovery”. Brain, Behavior, and Immunity 22.2 (2008): 129-139.
  11. His Label. ”Sensory sensitisation, part II: Pathophysiology at the dysfunctional State Identification of nerve internal play of livkan explain so far unexplained symptoms”. Medical journal 100.18 (2003).
  12. Jan Lidbeck. ”Central disturbed pain modulation explanation for chronic pain New knowledge is changing the perception of the problematic pain patient”. Swedish Medical Journal 96.23 (1999).
  13. Mats Lekander. ”Ecological lmmunology The Role of the Immune System in Psychology and Neuroscience”. European Psychologist 7.2 (2001) 98-115.
  14. David Yarnitsky., et al. ”Prediction of chronic post-operative pain”. Pain 138.1 (2008): 22-28.
  15. Julie Wieseler-Frank., et al. ”Immune-to-brain communication dynamically modulates pain: Physiological and pathological consequence”. Brain Behavior and Immunity 19.2 (2005): 104-111.
  16. JB Overmiera and Robert M. ”Trauma and resulting sensitization effects are modulated by psychological factors”. Psychoneuroendocrinology 30.10 (2005): 965-973.
  17. Vase N., et al. ”Cognitive-emotional sensitization contribute to wind-up-like pain In phantom limb pain patients”. Pain 152.1 (2011): 157-162.
  18. SOS (Swedish Social Board) Publications 1994/Treatment of longstanding pain.
Copyright: © 2015 Anders Öster and Ingalill Morén Hybbinette. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk