Pharmacologic management of pain in patients with Chikungunya: a guideline

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

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.