Hallo-Carrasco Alejandro, Hunt Christine L, Prusinski Christian C, Eldrige Jason S, McVeigh Kimberly H, Hurdle Mark Friedrich B, Prokop Larry J, Gupta Sahil
Pain Medicine, Mayo Clinic, Jacksonville, USA.
Library Services, Mayo Clinic, Rochester, USA.
Cureus. 2023 Feb 6;15(2):e34697. doi: 10.7759/cureus.34697. eCollection 2023 Feb.
International concerns for another pandemic arose after emerging reports of an ongoing outbreak of the monkeypox virus (MPXV) in Europe and the United States in 2022. Severe pain is one of the most distressing complications for patients in the current outbreak, but there is a general paucity of relevant peer-reviewed medical literature from which to draw clear recommendations on appropriate pain therapies. The Centers for Disease Control recently published a letter in July 2022 urging providers to conduct further studies concerning pain management. Thus, a rapid literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of several databases from inception until August 19, 2022, was conducted. All published studies describing pain in patients who tested positive for MPXV with original data and written in English were included. Sixty-nine studies were initially identified for screening. After initial screening, 27 papers were considered for full-text review, and 15 papers met the inclusion criteria. A total of 1043 positive cases were included in this study. Most patients were men. Treatment options proposed by the authors include acetaminophen, ibuprofen, opioids, lidocaine gel, metamizole, and rectal suppositories containing emollients or steroids with oral laxatives for severe anal pain. Although most cases were mild requiring outpatient treatment, a considerable number of patients were admitted due to serious complications. Severe pain was often the reason to seek medical attention and hospital admission for pain control. Analgesic plans included oral and topical analgesia. In severe cases, pain was managed with opioids. To our knowledge, this rapid review is the first study to comprehensively summarize proposed treatments for pain associated with MPXV. Guidelines may be needed to help direct the best management to avoid morbidity in patients, particularly as adjuvants may play a key role but are not commonly utilized in published reports.
2022年欧洲和美国出现猴痘病毒（MPXV）持续爆发的报道后，国际社会对另一场大流行产生了担忧。严重疼痛是当前疫情中患者最痛苦的并发症之一，但目前普遍缺乏相关的同行评审医学文献，无法从中得出关于适当疼痛治疗的明确建议。疾病控制中心最近在2022年7月发表了一封信，敦促医疗服务提供者对疼痛管理进行进一步研究。因此，我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了快速文献检索。对几个数据库从创建到2022年8月19日进行了全面检索。所有发表的描述MPXV检测呈阳性患者疼痛情况且有原始数据并以英文撰写的研究均被纳入。最初确定了69项研究进行筛选。初步筛选后，27篇论文被考虑进行全文评审，15篇论文符合纳入标准。本研究共纳入1043例阳性病例。大多数患者为男性。作者提出的治疗选择包括对乙酰氨基酚、布洛芬、阿片类药物、利多卡因凝胶、安乃近以及含有润肤剂或类固醇的直肠栓剂，并配合口服泻药治疗严重的肛门疼痛。虽然大多数病例症状较轻，需要门诊治疗，但仍有相当数量的患者因严重并发症而住院。严重疼痛往往是患者寻求医疗帮助和因疼痛控制而住院的原因。镇痛方案包括口服和局部镇痛。在严重病例中，使用阿片类药物控制疼痛。据我们所知，这项快速综述是第一项全面总结MPXV相关疼痛建议治疗方法的研究。可能需要制定指南来指导最佳治疗管理，以避免患者发病，特别是因为辅助药物可能起关键作用，但在已发表的报告中并不常用。
