An oxycodone-acetaminophen combination was prescribed. Laboratory findings at an emergency department were unremarkable other than a mild left shift in her white blood cell differential count (neutrophils, 81.9% ). Within 24 hours, the pain level increased to 8 or 9 on a scale of 0 to 10, causing a noticeable limp with ambulation. The extreme pain from many BRS bites motivates us to find better prevention and treatment techniques.Ī woman in her 20s noted a slight sensation similar to a mosquito bite on the medial knee surface. A larger series is needed to confirm the findings reported here. Escalation observed in 22 of 23 cases, increasing from low/none to extreme within 24 hours, is consistent with a cytokine pain pattern, in which pain increases concomitantly with a temporal increase of inflammatory cytokines.Ĭonclusions and Relevance These findings in BRS bites support the hypothesis of cytokine release in inflammatory pain. The difference in pain level by anatomic region was not significant. Narcotics may be needed to provide relief in some cases. The mean (SD) pain level in these cases 24 hours after the spider bite was severe: 6.74 (2.75) on a scale of 0 to 10. Observations Twenty-three BRS bites were scored at a probable or documented level clinically, and an enzyme-linked immunosorbent assay was used to confirm the presence of BRS venom. We propose cytokine release as a cause of the discomfort and a central mechanism through glial cell upregulation to explain measured pain levels and time course. Importance Bites from the brown recluse spider (BRS) can cause extreme pain. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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