Relief for Long-standing Postchikungunya Viral Myalgic and Arthralgic Pains Effected by Neuromodulation of Ultrasound-Guided Dry Needling of Affected Muscles and Steroid-Based Interventions

Abstract Chronic myalgias and arthralgias occur after Chikungunya virus infections (pCHIKV- M&A). We report details of treating a 6-years lasting CHIKV-M&A pains with a combination of medications and interventions. The patient had severe pain in bilateral shoulders and elbows; right thumb and back. Response to steroids, sulphasalazine and methotrexate was poor. Examination revealed M&A pains. Medications initiated included Pregabalin, Paracetamol, Tramadol and vitamin D. At two weeks, despite improvement, there were residual pains in bilateral shoulders and elbows. Four weekly sessions (two on each side), of ultrasound-guided dry needling (USGDN) of all muscles of the upper limb was done. Patient reassessment revealed moderate, residual pains at bilateral supraspinatus muscles, bicipital tendons and radio-humeral joints. These pains were addressed by USG guided steroid injection of bilateral- suprascapular nerves, bicipital tendons and radio-humeral joints. Medications reduced pains especially of back and thumb. USGDN of muscles further reduced it by 60%. The interventions at the nerves, entheses and joints gave 90%-100% relief. The pre-intervention Disability of Arm, Shoulder and Hand (DASH) score of 52.7 reduced to 5.4. At fifth month follow-up, the DASH was15.8, but patient reported satisfaction over pain relief, improvement in daily activities and quality-of-life. There are no evidence-based treatment guidelines or corroborative evidence for rheumatic pathology (most times) for persistent CHIKV-M&A pains. This case-report highlights the successful management of CHIKV-M&A pains by multi-modal approach. USGDN and steroids have neuro-modulatory effects. We have proposed that USGDN aids pain relief by an integrative role with the biologically inherent “chaos theory.”