Understand how the transmission of smallpox from monkeys skin to skin happens - Jornal O Sul

Doctors turn to morphine and other opioids in severe cases of monkeypox

Skin lesions caused by monkeypox can cause intense and even unbearable pain. (Photo: Reproduction)

Doctors have turned to morphine and other opioids to manage pain in patients with severe monkeypox. These diagnoses usually lead to hospitalization and have been more common in people with lesions in the genital or perianal region. Other rare cases also begin to appear and can lead to death or blindness with inflammation of the lung, brain and corneas.

According to the most recent report by the World Health Organization (WHO), 7.8% of all cases reported to date have led to hospitalization. To be classified as such, the condition can be characterized by one or more lesions that increase in size to the point where the pain is described as unbearable.

In these cases, the use of paracetamol or classic analgesics such as dipyrone and tylenol is ineffective and most patients need to receive morphine or another opioid such as tramadol (sold only by prescription) intravenously.

“The response that analgesics have in severe cases is quite poor and frustrating”, points out infectious disease specialist Rico Vasconcelos, from Hospital das Clínicas. “The option to escalate to opioids such as codeine and tramadol is also a bad idea if you have anal or perianal injury, because they can cause adverse events like constipation (drying stools). When we try to take the pain out of the patient, he ends up having more.”

Data from the Ministry of Health indicate that almost 60% of the patients registered so far have had a genital wound. Physicians, on the other hand, report that severe cases of monkeypox are commonly associated with lesions in this region, the perianal and, especially, the anal region. “These are the ones that most lead the patient to incurable and intractable pain”, points out Araújo.

lack of medicines

There is still no access to specific remedies against monkeypox or expectation of receiving sufficient doses to meet a large demand. The National Health Surveillance Agency (Anvisa) has already waived the import registration obligation for medicines and vaccines related to monkeypox, in an attempt to accelerate Brazil’s access to the few doses available in the world.

The situation, points out the infectologist, is the same lack of its own tools that Brazil suffered to fight the coronavirus. Throughout the pandemic, the country depended on the importation of inputs and doses, while the development of Brazilian technologies has not yet come to fruition. In the case of monkeypox, the scenario is worsened by the lack of drugs specifically aimed at this type of virus, since the only vaccine and the only medicine were created to treat smallpox.

With this, the fight against monkeypox in Brazil is once again dependent on the revolving fund of PAHO, the WHO arm in Latin America, to have vaccines and medicines indicated for the disease. The main challenge is that, again, there is “high demand in many countries”, as the director-general of the WHO recalled in his last statement on the outbreak, on Wednesday, 17.


Some rare cases of monkeypox can’t just depend on the passage of time. While the “severe” are still a minority, the disease has already manifested itself in at least three other “out of the curve” cases, with evolution of inflammation in the brain (encephalitis), lung (pneumonitis) and corneas (keratitis), also mentioned in the literature. international about the new outbreak.

For those patients in whom the symptoms and developments of the disease can put life or eyesight at risk, state and federal governments have tried to import specific doses through “compassionate use”.

On the list of requests for “compassionate use”, there are three drugs: Tecovirimat, developed for human smallpox but recommended by the WHO – PAHO, the entity’s Latin American arm, promised 50 doses of this type to Brazil; the antiviral Brincidofovir, used against other viruses of the Orthopoxvirus type; and Cidofovir, which also exists in the form of eye drops and is most commonly used for ophthalmological complications in patients with HIV/AIDS.

Despite not having a specific recommendation by the WHO or registration with Anvisa, the FDA (Food and Drugs Administration, a regulatory agency in the United States created recent protocols for the use of both in monkeypox patients, also warning that they can cause adverse effects. “Our goal is to manage pain and comfort, with local care, to preserve the patient’s life and then reduce pain and symptoms”, explains Uip. “But this virus will still bring surprises.”