What is the recommended treatment for severe body pain associated with dengue fever?

Treatment of Severe Body Pain in Dengue Fever

Acetaminophen (paracetamol) is the recommended first-line treatment for managing severe body pain associated with dengue fever, with careful monitoring for hepatic effects. 1

Pathophysiology and Clinical Presentation

• Dengue fever commonly presents with severe myalgia (muscle pain) and arthralgia (joint pain), particularly back pain, along with headache, retro-orbital pain, and rash 2
• The pain typically occurs during the acute febrile phase and can be debilitating, significantly affecting quality of life 1
• Pain management must be approached cautiously due to the risk of bleeding complications and potential hepatic involvement in dengue 1

First-Line Treatment Recommendations

• Acetaminophen (paracetamol) at standard doses (10-15 mg/kg every 4-6 hours, not exceeding 4 g/day in adults) is recommended for pain relief 1, 3
• Careful dosing is essential as a randomized controlled trial showed that even standard doses of paracetamol can increase transaminase elevation in dengue patients 4
• Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing liver disease or signs of hepatic involvement 1, 4

Contraindicated Medications

• Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are traditionally contraindicated due to potential increased bleeding risk in the setting of thrombocytopenia 1, 5
• The American Heart Association specifically advises avoiding aspirin and NSAIDs due to increased bleeding risk 1

Emerging Evidence on NSAIDs

• Recent research suggests that low-dose ibuprofen might be safe in non-severe dengue patients without evidence of bleeding or severe thrombocytopenia 6
• A 2025 retrospective study found no significant differences in platelet reduction, bleeding events, or progression to severe dengue between patients treated with low-dose ibuprofen versus acetaminophen 6
• However, until larger prospective studies confirm these findings, acetaminophen remains the first-line recommendation 1

Supportive Measures

• Rest and adequate hydration are essential components of pain management in dengue fever 2, 1
• Oral rehydration is appropriate for patients without signs of shock 1
• For patients with moderate dehydration, oral rehydration solution (ORS) should be given 2

Monitoring During Treatment

• Daily complete blood count monitoring is essential, particularly to track platelet counts and hematocrit levels 1
• Monitor for warning signs of severe dengue, including persistent vomiting, abdominal pain, lethargy, mucosal bleeding, and rising hematocrit with falling platelet count 7
• Watch for signs of hepatic involvement, which may necessitate reduction or discontinuation of acetaminophen 1, 4

Special Considerations

• For pregnant women with dengue fever, acetaminophen remains the safest analgesic option 2
• In children, acetaminophen dosing should be carefully calculated based on weight (10-15 mg/kg per dose) 8, 3
• In patients with pre-existing liver disease, consider reducing acetaminophen dosage and increasing monitoring frequency 1, 4

Common Pitfalls to Avoid

• Avoid excessive acetaminophen dosing, as it may worsen liver injury in dengue patients 4
• Do not use aspirin under any circumstances due to high bleeding risk 1
• Avoid delaying fluid resuscitation in patients showing signs of shock 1
• Do not fail to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1

Traditional Chinese Medicine Considerations

• For those seeking complementary approaches, certain traditional Chinese medicine formulations may help manage symptoms like fatigue and pain when used alongside conventional treatments 2
• HXZQ capsule/dropping pill combined with LHQW capsule/granule has shown efficacy for symptoms including limb pain and fatigue in some studies 2