Management of Severe Pain from Centipede Bite
For severe pain from centipede bites, immediately administer oral analgesics (acetaminophen or NSAIDs), apply ice packs to the bite site, and consider hot water immersion (as hot as tolerable without causing burns) which has shown clinical benefit for pain relief. 1
Immediate Pain Management
The cornerstone of centipede bite treatment is aggressive pain control, as the venom causes excruciating local pain and burning that can be severe in up to 50% of cases 1, 2:
- Administer oral acetaminophen or NSAIDs immediately for pain control 3, 4
- Apply ice packs with a clean barrier between ice and skin to provide local pain relief 3, 5
- Consider hot water immersion of the affected area—this intervention showed pain relief in clinical studies of centipede bites, with patients reporting benefit when immersing the bite area in hot water 1
The hot water immersion finding is particularly important as it distinguishes centipede bite management from typical arthropod envenomations. In the Australian prospective study, 4 patients specifically reported pain relief after hot water immersion 1.
Local Wound Care
After addressing pain, focus on preventing secondary complications 5, 6:
- Thoroughly irrigate the wound with copious amounts of warm water to remove any foreign matter 3, 5
- Apply antibiotic ointment and cover with a clean occlusive dressing to reduce infection risk 5, 6
- Remove rings and constricting objects from the affected extremity, as significant swelling commonly occurs 5, 6
- Elevate the affected limb if swelling is present 6
Role of Corticosteroids
For severe cases with extensive erythematous edema, consider a short course of oral corticosteroids (e.g., prednisone). 4 The case series from International Journal of Dermatology documented complete remission within two weeks using paracetamol combined with oral prednisone for severe Scolopendra bites presenting with severe erythematous edema 4. While guidelines for insect stings note that oral corticosteroids can be used for large local reactions, definitive proof through controlled studies is lacking 3.
What NOT to Do - Critical Pitfalls
Avoid interventions that are ineffective or harmful 3, 5:
- Do not apply suction to the bite site—this is ineffective and potentially harmful 3, 5
- Do not apply tourniquets or pressure immobilization bandages—these may worsen tissue injury 5, 6
- Do not assume antibiotics are needed for swelling around the bite site, as swelling is caused by venom-mediated inflammation, not infection 3, 5
Monitoring and Follow-up
Centipede bites are never fatal, but require monitoring 2:
- Most patients recover completely within 24-48 hours with local symptoms only 3, 5
- Monitor for signs of secondary infection: progressive erythema beyond the initial site, purulent discharge, fever, or elevated white blood cell count 3, 6
- Watch for rare complications: local bleeding (common but transient), blisters, or skin necrosis (occasional) 2, 7
- Systemic effects are extremely rare in centipede envenomation 1, 2
When to Seek Emergency Care
Immediate medical attention is warranted if 3, 5:
- Pain extends beyond the bite site or becomes uncontrolled by over-the-counter medications
- An open wound develops
- Signs of infection appear
- Any systemic symptoms develop (though these are exceedingly rare with centipedes)
Special Considerations
Hand bites may require more aggressive management and closer follow-up 6. The Australian study found that 93% of identified centipede bites occurred distally on hands or feet 1. Laboratory findings in severe cases may show leukocytosis and elevated ESR, but these are inflammatory responses rather than indicators of infection 4.