Management of chronic orofacial pain in pandemic of COVID-19


Manejo da dor orofacial crônica em tempos de pandemia de COVID-19

Wagner Hummig(1)
Bianca Lopes Cavalcante-Leão(2)
José Stechman-Neto(2)
1 Instituto de Neurologia de Curitiba, Setor de Cefaleia e Dor Orofacial (SCEDOF) - Curitiba - Paraná - Brazil.
2 Universidade Tuiuti do Paraná, Curso de Odontologia - Curitiba - Paraná - Brazil.

*Correspondence
Wagner Hummig
E-mail: waghum@hotmail.com
DOI: 10.5935/2178-7468.20200009

COVID-19 whose etiological factor is the SARS-CoV-2 coronavirus, is a new disease that plagues humanity and brings with it a real threat to physical integrity and profound repercussions on the individual’s mental health, especially in the face of doubts and uncertainties of the future1.

Global governments are adopting social detachment and isolation as measures in order to mitigate this pandemic. This tactic has revealed an exacerbation of important psychiatric disorders, such as: anxiety, depression and phobias to the most vulnerable groups2.

The impact of these protective measures were studied by Wang et al 2020 during the initial phase of the COVID-19 outbreak in China, and revealed that 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels3.

It is already known that there is a bidirectional relationship between chronic orofacial pain and psychosocial conditions and / or psychiatric disorders, forming a two-way street, where neural markers for fear and anxiety show the existence of an exacerbation process of painful symptoms4, being itself social isolation and mitigation methods the possible catalysts of pain events.

It  is  estimated that  chronic orofacial pain  (COP) affects 7%  of  the population4, a vulnerable group that is in social confinement and at the mercy of television news and social media that evoke fear and chaos in the face of the unknown.

The Brazilian government, after the Health Organization (WHO) decreed a pandemic by COVID-19, considered that only activities called urgency / emergency should be attended to, and this caused all elective appointments to be canceled.

Most of the patients with COP who were seen on an outpatient basis at the Chronic Pain Services (CPS) were considered non-urgent. Thus, in the face of this pandemic scenario, it is important to note that care for patients with chronic pain is extremely relevant to the individual’s quality and well- being, in addition to the fact that a large part of this group presents psychosocial changes as comorbidities in which the possible interruption pharmacological treatment can exacerbate such problems.

In order to assist the patient with COP in a complete and safe way, we encourage the use of telemedicine and online prescriptions with digital certification, and face-to-face assistance in selected urgent cases is recommended.

We consider this moment, that humanity is passing through, unique and with a great opportunity to implement and execute new clinical care tools, developing interpersonal and virtual skills.

 

REFERENCES

  1. Holmes EA, O’Connor RC, Perry VH, et al. Multidisciplinary research priori- ties for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020; pii: S2215-0366(20)30168-1.doi10.1016 S2215-0366(20)30168-1. [Epub ahead of print] Review.
  2. Ho CS, Chee CY, Ho RC. Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Ann Acad Med Singapore. 2020; 49: 155-160.
  3. Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020; 17: 1729.
  4. Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain. 2013; 14: 37. doi: 10.1186/1129-2377-14-37