eMedicine Specialties > Pulmonology > Pleural Disorders

Pleurodynia: Treatment & Medication

Author: Irina Petrache, MD, Associate Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University
Coauthor(s): Ninotchka Liban Sigua, MD, Fellow, Department of Pulmonary and Critical Care, Indiana University
Contributor Information and Disclosures

Updated: Apr 17, 2009

Treatment

Medical Care

No specific treatment exists. Management is supportive and includes nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and pleurisy (if present).

Aspirin should be avoided in children because of the potential to develop Reye syndrome.

Activity

As tolerated

Medication

Nonsteroidal anti-inflammatory drugs and analgesics are used for the symptomatic relief of pleurodynia.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but it may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, eg, inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation and various cell membrane functions. They are used for symptomatic relief of pleurodynia.13


Ibuprofen (Motrin, Advil)

Exerts anti-inflammatory effect via inhibition of cyclooxygenase, resulting in decreased formation of prostaglandins and thromboxanes from arachidonic acid. Also may inhibit synthesis and/or actions of other local inflammatory mediators and leukocyte migration. Analgesic effect is thought to result from the drug's action on peripheral pain impulse transmission and on pain receptor modulation.

Adult

400-800 mg PO q6-8h
If only analgesia is desired: 200-400 mg PO q6-8h

Pediatric

<6 months: Not established
>6 months: 20-40 mg/kg/d PO divided tid/qid
If only analgesia is desired: 5-10 mg/kg/d PO divided tid/qid

Coadministration with aspirin increases risk of inducing serious adverse effects; probenecid may increase concentrations and toxicity; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely in patients on warfarin (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; GI bleeding, severe peptic ulcer disease, severe coagulopathy

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in CHF, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy; adverse GI effects include dyspepsia, ulceration, bleeding, nausea, vomiting, and bloating; liver reactions may be severe and monitoring of liver function tests is recommended in prolonged use; may cause fluid retention and precipitate pulmonary edema in patients with severe heart failure; may cause blurred vision and visual field defects; may inhibit platelet aggregation, and may cause neutropenia, anemia, and thrombocytopenia; may interfere with labor, causing dystocia; may cause premature closure of ductus arteriosum


Ketoprofen (Orudis, Oruvail, Actron)

For relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses of more than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.

Adult

25-50 mg PO q6-8h prn; not to exceed 300 mg/d

Pediatric

25-50 mg PO q6-8h prn; not to exceed 300 mg/d

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in CHF, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy


Naproxen (Naprelan, Naprosyn, Anaprox, Aleve)

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Adult

500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d

Pediatric

<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrant further evaluation and may require discontinuation of drug

More on Pleurodynia

Overview: Pleurodynia
Differential Diagnoses & Workup: Pleurodynia
Treatment & Medication: Pleurodynia
Follow-up: Pleurodynia
References
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References

  1. Bell EJ, Grist NR. ECHO viruses, carditis, and acute pleurodynia. Am Heart J. Jul 1971;82(1):133-5. [Medline].

  2. Moore M, Kaplan MH, McPhee J, Bregman DJ, Klein SW. Epidemiologic, clinical, and laboratory features of Coxsackie B1-B5 infections in the United States, 1970-79. Public Health Rep. Sep-Oct 1984;99(5):515-22. [Medline].

  3. Kaplan MH, Klein SW, McPhee J, Harper RG. Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness. Rev Infect Dis. Nov-Dec 1983;5(6):1019-32. [Medline].

  4. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. Jul 2008;21(3):473-94. [Medline].

  5. Grattagliano I, Portincasa P, Mastronardi M, Palmieri VO, Palasciano G. Esomeprazole-induced central fever with severe myalgia. Ann Pharmacother. Apr 2005;39(4):757-60. [Medline].

  6. Rotbart HA, Sawyer MH, Fast S, Lewinski C, Murphy N, Keyser EF, et al. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol. Oct 1994;32(10):2590-2. [Medline].

  7. Romero JR. Reverse-transcription polymerase chain reaction detection of the enteroviruses. Arch Pathol Lab Med. Dec 1999;123(12):1161-9. [Medline].

  8. Nolte FS. Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis. Dec 1 2006;43(11):1463-7. [Medline].

  9. Noordhoek GT, Weel JF, Poelstra E, Hooghiemstra M, Brandenburg AH. Clinical validation of a new real-time PCR assay for detection of enteroviruses and parechoviruses, and implications for diagnostic procedures. J Clin Virol. Feb 2008;41(2):75-80. [Medline].

  10. Patel DD, Kapoor A, Ayyagari A, Dhole TN. Development of a simple restriction fragment length polymorphism assay for subtyping of coxsackie B viruses. J Virol Methods. Sep 15 2004;120(2):167-72. [Medline].

  11. Goldwater PN. Immunoglobulin M capture immunoassay in investigation of coxsackievirus B5 and B6 outbreaks in South Australia. J Clin Microbiol. Jun 1995;33(6):1628-31. [Medline].

  12. McCartney RA, Banatvala JE, Bell EJ. Routine use of mu-antibody-capture ELISA for the serological diagnosis of Coxsackie B virus infections. J Med Virol. Jul 1986;19(3):205-12. [Medline].

  13. McEvoy GK. Nonsteroidal Anti-inflammatory Agents. In: AHFS Drug information. Bethesda, Md: American Society of Health-System Pharmacists; 2000.

  14. Ikeda RM, Kondracki SF, Drabkin PD, Birkhead GS, Morse DL. Pleurodynia among football players at a high school. An outbreak associated with coxsackievirus B1. JAMA. Nov 10 1993;270(18):2205-6. [Medline].

  15. Druce JD, Russell JS, Birch CJ, Vickery K, Harper RW, Smolich JJ. Cleaning and sterilization protocol for reused cardiac electrophysiology catheters inactivates hepatitis and coxsackie viruses. Infect Control Hosp Epidemiol. Aug 2005;26(8):720-5. [Medline].

  16. Bell EJ, McCartney RA, Riding MH. Coxsackie B viruses and myalgic encephalomyelitis. J R Soc Med. Jun 1988;81(6):329-31. [Medline].

  17. Dussart P, Cartet G, Huguet P, Lévêque N, Hajjar C, Morvan J, et al. Outbreak of acute hemorrhagic conjunctivitis in French Guiana and West Indies caused by coxsackievirus A24 variant: phylogenetic analysis reveals Asian import. J Med Virol. Apr 2005;75(4):559-65. [Medline].

  18. Huber S, Ramsingh AI. Coxsackievirus-induced pancreatitis. Viral Immunol. 2004;17(3):358-69. [Medline].

  19. Spotnitz MD, Lesch M. Idiopathic dilated cardiomyopathy as a late complication of healed viral (Coxsackie B virus) myocarditis: historical analysis, review of the literature, and a postulated unifying hypothesis. Prog Cardiovasc Dis. Jul-Aug 2006;49(1):42-57. [Medline].

  20. Thomas L, Reichl M. Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain. Arch Emerg Med. Mar 1991;8(1):48-51. [Medline].

  21. Ornoy A, Tenenbaum A. Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses. Reprod Toxicol. May 2006;21(4):446-57. [Medline].

  22. Branch WT Jr, McNeil BJ. Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults. Am J Med. Oct 1983;75(4):671-9. [Medline].

  23. Dagan R, Jenista JA, Prather SL, Powell KR, Menegus MA. Viremia in hospitalized children with enterovirus infections. J Pediatr. Mar 1985;106(3):397-401. [Medline].

  24. Disney ME, Howard EM, Wood BS, Findlay GM. Bornholm disease in children. Br Med J. Jun 20 1953;1(4824):1351-4. [Medline].

  25. Fraser RG, Pare JA. Coxsackievirus respiratory infection. Diag Dis Chest. 1978;2:834-35.

  26. Lau RC. Coxsackie B virus infections in New Zealand patients with cardiac and non-cardiac diseases. J Med Virol. 1983;11(2):131-7. [Medline].

  27. Mintz L, Drew WL. Relation of culture site to the recovery of nonpolio enteroviruses. Am J Clin Pathol. Sep 1980;74(3):324-6. [Medline].

  28. Murray BJ. Complications following coxsackievirus B infection. Am Fam Physician. Nov 1988;38(5):115-8. [Medline].

  29. Pichichero ME, McLinn S, Rotbart HA, Menegus MA, Cascino M, Reidenberg BE. Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics. Nov 1998;102(5):1126-34. [Medline].

  30. Roth B, Enders M, Arents A, Pfitzner A, Terletskaia-Ladwig E. Epidemiologic aspects and laboratory features of enterovirus infections in Western Germany, 2000-2005. J Med Virol. Jul 2007;79(7):956-62. [Medline].

  31. Storch GA. Essentials of Diagnostic Virology. New York, NY: Churchill Livingstone; 2000.

  32. Swanink CM, Veenstra L, Poort YA. Coxsackievirus B1-based antibody-capture enzyme-linked immunosorbent assay for detection of immunoglobulin G (IgG), IgM, and IgA with broad specificity for enteroviruses. J Clin Microbiol. Dec 1993;31(12):3240-6. [Medline].

  33. Wilson PM, Kusumakar V, McCartney RA, Bell EJ. Features of Coxsackie B virus (CBV) infection in children with prolonged physical and psychological morbidity. J Psychosom Res. 1989;33(1):29-36. [Medline].

  34. Yagi S, Schnurr D, Lin J. Spectrum of monoclonal antibodies to coxsackievirus B-3 includes type- and group-specific antibodies. J Clin Microbiol. Sep 1992;30(9):2498-501. [Medline].

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Further Reading

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Keywords

pleurodynia, pleuritis, pleuritic pain, lancinating chest pain, costalgia, epidemic pleurodynia, Bornholm disease, Bornholm's disease, Devil grip, Devil's grip, epidemic myalgia, coxsackievirus B, enteroviruses, meningitis, carditis, Sylvest's disease, Sylvest disease, epidemic benign dry pleurisy

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Contributor Information and Disclosures

Author

Irina Petrache, MD, Associate Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University
Irina Petrache, MD is a member of the following medical societies: American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Ninotchka Liban Sigua, MD, Fellow, Department of Pulmonary and Critical Care, Indiana University
Ninotchka Liban Sigua, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Helen M Hollingsworth, MD, Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center
Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gregg T Anders, DO, Medical Director, Great Plains Regional Medical Command , Brook Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio
Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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