Pharmacologic management of pain in patients with Chikungunya: a guideline.

Carlos Alexandre Antunes De Brito,Lilian David De Azevedo Valadares,Ana Karla Arraes Von Sohsten,Clezio Cordeiro De Sá Leitão,Helena Maria Carneiro Leão,Rita De Cássia Coelho Moraes De Brito Brito,Kleber Luz,Rivaldo Venâncio Cunha,Caroline Araújo Magnata Da Fonte,Zelina Barbosa De Mesquita,Lívia Carla Vinhal Frutuoso,Cecília Moraes De Brito

doi:10.1590/0037-8682-0279-2016

Abstract

From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.

Highlights

From the arrival of the Chikungunya virus (CHIKV) in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported
Some groups of specialists from different fields have developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review
A group of specialists from different fields collaborated to produce a protocol for the pharmacologic treatment of acute and chronic Chikungunya-associated joint pain; it is presented in this review

Summary

INTRODUCTION

From the arrival of the Chikungunya virus (CHIKV) in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. There is a lack of systematized practice of using staggered therapy according to the intensity of the pain and reassessment after failure/success of the drug administered Given this need, a group of specialists from different fields collaborated to produce a protocol for the pharmacologic treatment of acute and chronic Chikungunya-associated joint pain; it is presented in this review. In the sub-acute and chronic phases of arthralgia, a history of having had an episode of acute fever with associated edema and joint pain during an epidemic period (clinical-epidemiologic criteria) dispenses with the need to perform serologic tests in patients that seek assistance for the treatment of pain. The pain scale (VAS) and DN4 questionnaire Consider the use of corticosteroids according to the protocol (Sub-acute phase) in selected cases [1] Analgesics: take in fixed, regular doses and never use when necessary. Question 2: Is the pain associated with one or more of the following symptoms in the same area?

Itching

Findings

CONCLUSION