Welcome back.
The next part of this module on the environment is about infection risk.
Again, this is part of the environment and being clean, organized, and avoiding risk.
So, it's about staying clean and healthy.
And there's a variety of infections that can develop as
a result of just being uncareful or unclean in our environment.
Here's an example of a Herpes zoster or shingles.
It's a viral nerve infection that can cause a
painful skim rash, skin rash with blisters, short term.
But on the long term, the possibility of a chronic burning pain.
And it frequently occurs in the area of the
trigeminal nerve, the ophthalmic division or the maxillary division.
You can see the Herpes zoster lesions that occur with it.
And here's a study done of herpes zosters to determine what risk factors were
involved in developing chronic pain at 12 months with a herpes zoster infection.
Well, the risk factors include the initial pain severity, the more
severe the pain is, the higher chance of continuing to have pain.
But interesting, some psycho-social factors.
Emotional factors like state anxiety and depression did increase
the risk of chronic pain after Herpes zoster infection.
And lower life satisfaction and greater disease
conviction were all, interestingly enough, risk factors.
If you get herpes zoster.
Herpes zoster is typically a virus but when your immune system is decreased,
then it has the potential to be infecting a specific nerve.
So, prevention involves really get immunized Immunizations can play
a role in really preventing the development of herpes zoster.
Early treatment with anti-viral medications is appropriate.
Injection with steroids and anesthetics can stop
the inflammation and nerve damage that can occur.
Of course, patient education and maintaining
the immune system is really very important.
Now, another infection that can contribute to chronic
pain and be a chronic infection is osteomyelitis.
Now this is an infection of the bone cause by, most
often, Staphylococcus aureus, but other infective agents can also play a role.
Symptoms include pain and tenderness.
A lump in the infected bone or overlying skin, fever, fatigue, and malaise.
And it can occur after infection in another part of the
body, an injury or a deep skin lesion close to the bone.
Now, this will most commonly affect the long bones like, for
instance, the femur in the leg, the tibia or the fibula.
Those leg bones as well as some times in the jaw bone as result of a jaw infection
and here's an example of osteomyelitis of the jaw bone after a dental infection.
So, risk factors for osteomyelitis include previous osteomyelitis,
or a recent fracture or surgery to the
bone, bone or joint replacement prosthesis, particularly combined
with a history of infection in that area.
If you have a poor immune system, like
you're, you're having chemotherapy, cancer, seriously ill, or AIDS,
an injection of street drugs will also increase infection
risk, and can play a role in developing osteomyelitis.
Dependence on alcohol reduces immune function, and of course,
within the jaw area here, dental caries and periodontal disease.
And other co-morbid conditions seem to be a risk too, with like sickle cell disease,
diabetes, kidney dialysis, skin infections, and even
taking steroids regularly may increase that infection risk.
Now another infection, that I see a lot in, in my
clinic as a, dental provider, an oral facial pain, provider is Candidiasis.
And you can see a picture of a
yeast infection, or also called thrush, thrush mouth
that can cause kind of a burning pain
within the tongue, that continues on, over and over.
And it occurs in the mouth, the tongue, the
skins, in the genital area, as well as other areas.
And it leads to, kind of, a neural or nerve
hyper-sensitivity and hyper-innervation, even after
resolution of the infection and inflammation.
So it does injure the peripheral nerve.
And risk factors include overuse of antibiotic drugs.
So there's an imbalance within the system.
Poor immune system, again, similar to
osteomyelitis and regular estrogen in birth
control pills and hormone replacements seem to be a risk factor also.
And then, poor oral hygiene and poor diet, high sugar
diets increases inflammation, increases the possibility of a yeast infection.
And it can spread through sexual contact, too, so you have to be aware of that.
Now, another infection that contributes to chronic pain is Lyme disease.
Now 10 to 20% of the people with Lyme disease will have a continued
pain, fatigue, joint and muscle pain even after 2 to 4 weeks of antibiotics.
So, possible causes of this continued pain includes damage to the tissues from the
infection of course but also a reduction in the immune system by the, disease.
This is caused by ticks and you can see the deer tick right here and the typical
bullet lesion that you would have on your leg
or your body from the tear, deer tick bite.
And then an auto immune response can play a role, too.
Protective factors include continued antibiotics but not long term, long term
can contribute to other problems like I just said, the candidiasis.
Maintaining a healthy diet of high protein, high fruits and vegetables, low
sugar low fat will, will help protect you from long term chronic pain.
Supplements, sleeping well and exercise are all protective factors
to prevent the long term effects of Lyme disease.
And usually it resolves with the antibiotics.
Now, another chronic infection that I see quite a bit also as
well as in your nose and throat physician, specialists, is chronic sinusitis.
And this develops initially from a cold or flu like illness, due to either
a virus, sometimes a dental infection and it can become chronic with risk factors.
And the number of risk factors it can play a role,
including allergic rhinitis due to airborne allergies that a person may have.
A blockage of the sinus from either nasal
polyps, objects, facial injuries, tumors, or even surgery.
And then, a history of pulmonary problems, respiratory problems,
such as asthma, cystic fibrosis or other lung diseases.
Again, a weak immune system can play a role with all these infections.
Your body's just not taking care of the the bacteria virus.
And in the condition such as
comorbid conditions, diabetes, pregnancy, HIV, inflammatory
disorders, smoking, of course, because it is a air pollutant, air particles.
And as well as air, air pollutions
indoors or outdoors, sniffing or inhaling substances that
irritate the lining of the nose and the
sinuses, such as cocaine is a good example.
And previous injury to the nose or cheeks can
all play a role in causing a sinus infection to
become chronic and recurring over time, causing pain in
the maxilla, and in the, between the eyes, right here.
Now, there are also, post surgical infections
that we have to be cautious about, too.
And Staphylococcus aureus, are also one of those major
agents that can contribute to a post surgical infection.
There are some Staphylococcus bacteria that
are Methicillin resistant and, and thus, typical
antibiotics may not control it and this can cause infection and chronic pain.
Risk factors for these post surgical infections
including, of course, co-morbid conditions that we've discussed
in the other ones, previous spinal interventions
or nerve blocks can, can play a role.
Surgery for degenerative disease or trauma, drug injection or catheter
placement, other infections including osteomyelitis or soft tissue infections,
and of course, epidural fluid collections sometimes can play a
role by infecting the place where the epidural is placed.
So then there's infection risk after surgery but
for injection, surgery, or devices, there's about 2
million cases per year or about 10% of
all hospital surgeries, acquire a hospital based infection.
And this can, in some cases, lead to a chronic pain problem.
And the most common pain treatments that have some risk includes surgical implants,
joint implants, hip implants, knee implants, TMJ or jaw implants.
And there's about 2 to 7% of those patients that develop an infection.
Epidural steroid injections, that I mentioned before, is about 2%.
Facet or trigger-point injections, 2%.
Permanent epidural catheters, this is the highest
incidence of infections, include 50 to 90%
of patients because this is something that
is permanent and allows for bacteria or other
agents to get into the epidural space, causing infections, so that has to be
cautious about, and then central IV catheters
is also a very common source of infections.
Now, there are risk factors for these infections and two of them that
are probably the most common cited in all the efforts by hospitals to really
improve their infection control, and reduce
the chance of a hospital based infection,
and that is the efforts towards poor correcting any type of poor hand hygiene.
So they recommend using alcohol gel which
dries quickly, is bacteriacidal, fungicidal, and viruscidal also.
And then weak immune systems from co-morbid
conditions, those patients have to be much more
carefully monitored to minimize the chance of
infections from diabetes, cancer, HIV, chemotherapy and radiation.
The general policy on these infections is to treat them
with early antibiotics and then to rotate the antibiotics periodically.
So it improves general outcomes and so
the bacteria, do not become antibiotic, resistant.
And then prophylaxis with antimicrobial drugs during implantation
also seems to help considerable antibiotics during this.
So those are some of the issues surrounding infections.
And it's not a huge problem but it is something for those
patients, who develop chronic pain after
infections, it can be a significant problem.
So, thank you.