2023 FSA Podium and Poster Abstracts

P061: PAIN MANAGEMENT IN MONKEYPOX: CASE REPORT
Nathalia Torres Buendia, MD; G Castella, MD; R Weisman, MD; University of Miami, Miller School of Medicine

Introduction: From January to December of 2022, 82.624 confirmed cases of Mpox have been reported to the World Health Organization (WHO). The country with the highest number of reported cases is the United States with 29.513 (1).

Hospitalization rate has been found to be around 35% (2) and severe pain is one the main criteria for hospital admission (3). With 50% of the patients presenting with more than 100 cutaneous lesions (4) pain management becomes one of the main goals in the medical care of this population.

Up to date, no specific pain management guidelines for Mpox patients have been published.

Case Description: We present a case of a 40year-old male with a HIV and agoraphobia who presented with a four day history of throat and neck pain. Patient reported decreased oral intake secondary to severe throat pain, intermittent fever, weight loss, and headaches with photophobia. Patient took acetaminophen and ibuprofen at home with no relief.

Upon arrival to Jackson Memorial Hospital, patient underwent a CT neck with findings suspicious for acute tonsillitis with tonsillar abscess, cervical lymphadenopathy and cystic lesions in parotid glands. Patient was admitted for I&D of tonsillar abscess, IV antibiotic therapy and pain management.

On hospital day one pruritic papules and pustules located on the chest, extremities, dorm of feet, genitals and hard palate appeared. Patient was tested and diagnosed with a Mpox infection, started on antiviral therapy and the Acute Pain Service was consulted for pain medication recommendations.

He had constant pain and pruritus from his skin lesions as well as neuropathic pain located along thoracic spine which he described as “burning.”

Pain medications regimen included scheduled acetaminophen liquid, oxycodone liquid, gabapentin and hydromorphone IV as needed for breakthrough pain. He was started on an NSAID initially but secondary to an increase in serum creatinine, was discontinued. Patient also received Magic Mouthwash, topical lidocaine cream and calamine lotion for skin lesions.

He reported improved pain control with this medication regimen and was able to be tapered off opioids as infection cleared.

Discussion: Mpox outbreak in 2022 has been declared a public health emergency of international concern by the WHO statement of July 23rd. As such, the rising number of cases in non-endemic areas can continue to increase urging for a better understanding of the disease transmission, progression and treatment.

As recently published the most common manifestations are fever, pruritic skin rash and lymphadenopathy. Our case describes a classical presentation of Mpox that required inpatient management due to superimposed bacterial infection and severe pain.

A multimodal analgesia regimen targeting inflammation, somatic and neuropathic pain was successfully administered while closely monitoring renal and hepatic function markers. Multiple routs of administration; topical, oral, and IV where required to fully cover the patient’s nociceptive symptoms. Within a few days pain was improved and patient fully recovered.

This case highlights the importance of understating the complex pain mechanisms that can simultaneously concur in the Mpox patient bringing awareness to the benefits of an integral pain management strategy.

Conclusions: Pain management should be a pillar in the care of this population.

Optimization of pain management can potentially reduce hospitalization length of stay and associated complications of Mpox.