Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190060
Brazilian Journal of Pain
Original Article

Clinical manifestations in patients with musculoskeletal pain post-chikungunya

Manifestações clínicas em pacientes com dores musculoesqueléticas pós-chikungunya

Ben-Hur James Maciel de-Araujo; Patricia Bueno Nestarez Hazime; Francisca Joyce Vasconcelos Galeno; Laís Nascimento Candeira; Mayare Fortes Sampaio; Fuad Ahmad Hazime

http://dx.doi.org/10.5935/2595-0118.20190060 BrJP, vol.2, n4, p.326-330, 2019
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Abstract

BACKGROUND AND OBJECTIVES: Chronic clinical manifestations of the chikungunya virus infection are associated with high rates of disability and worsening of quality of life, representing one of the major challenges for global public health. The objective of this study was to investigate the clinical-psycho-functional presentation of the chikungunya virus-infected individuals with complaints of chronic musculoskeletal pain.

METHODS: Twenty-two individuals with a diagnosis of chikungunya virus infection and a complaint of persistent musculoskeletal pain (≥3 months) participated in the study. The clinical-psycho-functional evaluation was performed through the intensity and affective-emotional aspect of pain, quality of life, kinesophobia, global perception of post-infection pain recovery and emotional functionality. In the end, the pressure pain threshold and the conditioned pain modulation were evaluated.

RESULTS: The clinical presentation of pain revealed long persistence 17.5±7.4 months; predominant in the lower limbs (45.5%); mean intensity (5.5±2.1); mild to moderate affective-emotional changes; moderate kinesophobia (46±6.5) and low overall perception of improvement (1.5±2.5). The Beck Depression Inventory and the visual analog scale for anxiety showed little change. Quality of life presented mild to moderate impairment, and pain modulation showed a slight increase in the pressure pain threshold (6.3%).

CONCLUSION: The chronic phase of the chikungunya virus infection is characterized by persistent moderate-intensity pain, both in sensory and affective levels, with moderate kinesophobia, worsening of quality of life, perception of poor post-infection recovery, and a decrease in the pain descending inhibitory pathways.

Keywords

Chikungunya virus, Chronic pain, Clinical evolution, Signals and symptoms

Resumo

JUSTIFICATIVA E OBJETIVOS: As manifestações clínicas crônicas da infecção pelo vírus chikungunya estão associadas a altos índices de incapacidade e piora da qualidade de vida, representando um dos grandes desafios para a saúde pública mundial. O objetivo deste estudo foi investigar a apresentação clínica-psico-funcional de indivíduos infectados pelo vírus chikungunya com queixas de dores musculoesqueléticas crônicas.

MÉTODOS: Participaram do estudo 22 indivíduos com diagnóstico de infecção pelo vírus chikungunya e queixa de dor musculoesquelética persistente (≥3 meses). A avaliação clínica-psico-funcional foi realizada por meio da intensidade e aspecto afetivo-emocional da dor, qualidade de vida, cinesiofobia, percepção global de recuperação da dor pós-infecção e funcionalidade emocional. Ao final foi avaliado o limiar de dor por pressão e a modulação condicionada da dor.

RESULTADOS: A apresentação clínica da dor revelou longa persistência, 17,5±7,4 meses; predominância nos membros inferiores (45,5%); intensidade média (5,5±2,1); alterações afetiva-emocionais leves a moderadas; moderada cinesiofobia (46±6,5) e baixa percepção global de melhora (1,5±2,5). O Inventário de Depressão de Beck e a escala analógica visual para ansiedade apresentaram pouca alteração. A qualidade de vida apresentou prejuízos leves a moderados, e a modulação da dor revelou pouco aumento do limiar de dor por pressão (6,3%).

CONCLUSÃO: A fase crônica da infecção pelo vírus chikungunya tem como apresentação clínica dor persistente de moderada intensidade, em nível sensorial e afetivo, além de moderada cinesiofobia, piora na qualidade de vida, percepção de pouca recuperação pós-infecção e diminuição da ativação inibitória descendente da dor.

Palavras-chave

Dor crônica, Evolução clínica, Sinais e sintomas, Vírus chikungunya

References

Pialoux G, Gaüzère BA, Jauréguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis. 2007;7(5):319-27.

Ross RW. The Newala epidemic: III. The virus: isolation, pathogenic properties and relationship to the epidemic. J Hyg. 1956;54(2):177-91.

Dash PK, Parida MM, Santhosh SR, Verma SK, Tripathi NK, Ambuj S. East Central South African genotype as the causative agent in reemergence of Chikungunya outbreak in India. Vector Borne Zoonotic Dis. 2007;7(4):519-27.

Harapan H, Michie A, Mudatsir M, Nusa R, Yohan B, Wagner AL. Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis. BMC Infect Dis. 2019;19(1):243.

Gérardin P, Guernier V, Perrau J, Fianu A, Le Roux K, Grivard P. Estimating Chikungunya prevalence in La Réunion Island outbreak by serosurveys: two methods for two critical times of the epidemic. BMC Infect Dis. 2008;8:99.

Simo FBN, Bigna JJ, Well EA, Kenmoe S, Sado FBY, Weaver SC. Chikungunya virus infection prevalence in Africa: a contemporaneous systematic review and meta-analysis. Public Health. 2019;166:79-88.

Boletim Epidemiológico. 2014:1-6.

Castro AP, Lima RA, Nascimento JS. Chikungunya: vision of the pain clinician. Rev Dor. 2016;17(4):299-302.

Chikungunya: Manejo Clínico. 2017.

McCarthy MK, Morrison TE. Chronic chikungunya virus musculoskeletal disease: what are the underlying mechanisms?. Future Microbiol. 2016;11(3):331-4.

Soumahoro MK, Gérardin P, Boëlle PY, Perrau J, Fianu A, Pouchot J. Impact of Chikungunya virus infection on health status and quality of life: a retrospective cohort study. PLoS One. 2009;4(11).

Couturier E, Guillemin F, Mura M, Léon L, Virion JM, Letort MJ. Impaired quality of life after chikungunya virus infection: a 2-year follow-up study. Rheumatology. 2012;51(7):1315-22.

Sales GM, Barbosa IC, Canejo Neta LM, Pelo PL, Leitão RA, Melo HMA. Treatment of chikungunya chronic arthritis: a systematic review. Rev Assoc Med Bras. 2018;64(1):63-70.

Marimoutou C, Ferraro J, Javelle E, Deparis X, Simon F. Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later. Clin Microbiol Infect. 2015;21(7):688-93.

de Souza FS, Marinho Cda S, Siqueira FB, Maher CG, Costa LO. Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties. Spine. 2008;33(9):1028-33.

Menezes Costa Lda C, Maher CG, McAuley JH, Hancock MJ, de Melo Oliveira W, Azevedo DC. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol. 2011;64(8):903-12.

EQ-5D: a standardised instrument for use a measure of health outcome EQ-5D translations. 2010.

Shiro Y, Ikemoto T, Terasawa Y, Arai YP, Hayashi K, Ushida T. Physical activity may be associated with conditioned pain modulation in women but not men among healthy individuals. Pain Res Manag. 2017;2017:9059140.

Knudsen L, Drummond PD. Cold-induced limb pain decreases sensitivity to pressure-pain sensations in the ipsilateral forehead. Eur J Pain. 2009;13(10):1023-9.

Gorenstein C, Andrade L, Vieira Filho AH, Tung TC, Artes R. Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students. J Clin Psychol. 1999;55(5):553-62.

Williams VS, Morlock RJ, Feltner D. Psychometric evaluation of a visual analog scale for the assessment of anxiety. Health Qual Life Outcomes. 2010;8:57.

Bhatia MS, Gautam P, Jhanjee A. Psychiatric morbidity in patients with chikungunya fever: first report from India. J Clin Diagn Res. 2015;9(10):VC01-3.

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012;36(5):427-40.

Naugle KM, Fillingim RB, Riley 3rd JL. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012;13(12):1139-50.

Polaski AM, Phelps AL, Kostek MC, Szucs KA, Kolber BJ. Exercise-induced hypoalgesia: a meta-analysis of exercise dosing for the treatment of chronic pain. PLoS One. 2019;14(1).

Souza CG, da Costa JF, de Sousa Dantas D, de Abreu Freitas RP, Lopes JM. Evaluation of pain, functional capacity and kinesiophobia in women in the chronic stage of chikungunya virus infection: a cross-sectional study in northeastern Brazil. Acta Trop. 2018;199.

Lewis GN, Rice DA, McNair PJ. Conditioned pain modulation in populations with chronic pain: a systematic review and meta-analysis. J Pain. 2012;13(10):936-44.

Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, Ben-Nun A, Sprecher E. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk. Pain. 2008;138(1):22-8.

Wilder-Smith OH, Schreyer T, Scheffer GJ, Arendt-Nielsen L. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study. J Pain Palliat Care Pharmacother. 2010;24(2):119-28.

Vaegter HB, Handberg G, Graven-Nielsen T. Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain. 2014;155(1):158-67.

O'Connell NE, Marston L, Spencer S, DeSouza LH, Wand BM. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev. 2018;3.

Submitted date:
06/03/2019

Accepted date:
09/23/2019

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