Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Is Serratiopeptidase a Placebo Treatment for the Chronic Pain at the Vaccination Site Following MR Vaccination?

Ashok Pandey*, Arya Gautam

Medical Officer Urban Health Promotion Centre, Butwal, Nepal

Abstract: Background: Serratiopeptidase is an enzymatic drug that has anti-inflammatory and analgesic effects. Chronic pain at the site of vaccination is considered as an AEFI. In this report, we discuss a case of a 16-year-old female with chronic pain following vaccination and use of serratiopeptidase as an analgesic for her symptoms. Case Presentation: A 16-year-old female came to the primary health care center with pain in the left arm (over the deltoid region) followed by MR vaccination. On examination, there were no any neuromuscular deficits. Her pain was graded 6/10 according to the Numerical Rating Scale for pain. She was given serratiopeptidase for 10 days, which led to the resolution of her symptoms. Conclusion: Here, the case of chronic pain followed by vaccination is presented where the patient was prescribed with serratiopeptidase following failure to resolve her symptoms by other means. Despite the lack of any solid clinical evidence supporting its usage, patient outcome questions whether it is actually a potent analgesic or a placebo drug.

Keywords: Adverse event following immunization, Chronic pain, Measles-Rubella Vaccination, Serratiopeptidase, Analgesic

Received May 26, 2024; Revised June 28, 2024; Accepted July 04, 2024

Citation: Ashok Pandey, Arya Gautam, Is Serratiopeptidase a Placebo Treatment for the Chronic Pain at the Vaccination Site Following MR Vaccination?. American Journal of Medical Case Reports, 12 (6). 91-92. January 2024. doi:10.12691/ajmcr-12-6-3

1. Introduction

Serratiopeptidase is promoted as an anti-inflammatory agent and an analgesic drug, although the clinical data suggest that the efficacy of the drug is limited. Serratiopeptidase is usually used at an adult dosage of 10 mg thrice daily. Serratiopeptidase is an extracellular proteolytic enzyme produced by Serratia marcescens which is a type of bacteria isolated from the intestine of the silkworm Bombyx mori. [1]

Chronic pain at the vaccination site is a type of an AEFI. The AEFI includes an array of adversities that occur in the vaccinated individuals following vaccination at different time frames. Some of the AEFIs are acute, while some occur several days after vaccination. Acute reactions include the appearances of rashes, fever, difficulty in breathing and generalized itching, which can lead to a lethal reaction, anaphylactic shock. [2]

Out of the late adversities observed following vaccination, pain at the site of vaccination is the commonly encountered adverse event by general practitioners. In the report, 16-year-old female with pain at the site of vaccination is described.

2. Case Presentation

A 16-year-old female came to the primary health care center with the chief complaint of pain in the left arm (over the deltoid region) at the site of vaccination followed by measles-rubella vaccination. She was vaccinated during the nationwide Measles-Rubella vaccination campaign, which started between February 25th and March 3rd, 2024.

She had experienced mild pain following the vaccination which gradually increased in severity over a period of 4 weeks. Her pain became severe following the use of her arm while performing daily chores and other usual activities. The NRS was used for grading the pain, which came out was 6/10 as described by the patient. [3]

On examination, there was no tenderness upon palpation. Moreover, there was no limitation in the range of motion of the arm. She did not complain of any tingling sensation or any numbness in the deltoid region. The biceps and tendon reflexes were elicited normally, and the power in her arm was 5/5. [4]

She had been prescribed NSAIDS for her symptoms with no avail over the period of 3 weeks. She had no history of intake of any other medications.

She had no history of similar symptoms following vaccination in the past. There was no history of any psychiatric illness in the patient or in the family. There was no history of chronic pain in the family.

She had undergone X-ray imaging of her left shoulder including the forearm, in the anteroposterior and lateral views, no abnormalities were observed in the X-ray image.

As she had no any positive outcomes following the administration of NSAIDS, she was prescribed the following medication:

- Tab. Serratiopeptidase 5 mg per oral b.i.d. for 5 days.

She was informed about the limited clinical studies suggesting the analgesic role of this drug. She was also counseled regarding possible complications following vaccination, as her symptoms might suggest one of them. She was asked to visit the center again after 5 days.

Following the completion of the doses, she visited the center again. She experienced a marked reduction in her symptoms and the distress. Using the NRS to rate her pain after the use of medication for 5 days, she stated that her pain was now 2/10. [3] She was then prescribed the same medication for 5 more days and was asked to visit the center after 5 days. She subsequently presented with no symptoms.

3. Discussion and Conclusion

Serratiopeptidase is an enzymatic drug with anti-inflammatory and mild analgesic effects. Furthermore, inhibiting the release of pain-inducing amines such as bradykinin from inflamed tissues may help alleviate pain. [5]

It is also available in different combinations along with NSAIDS, such as diclofenac, acetaminophen(paracetamol), and aceclofenac. In particular, the analgesic activity of serratiopeptidase, which is said to be due to its ability to block the release of biogenic amines, needs to be evaluated with appropriate research methodology. The studies that have been conducted to date are mostly placebo-controlled trials and lack an active comparator. However, further extensive clinical studies need to be conducted before its therapeutic effects are well defined.

In the case discussed above, multiple factors might have contributed to her chronic pain. She might have a low threshold of pain, or not been counseled well about the pain that might occur following the vaccination. Psychosocial factors might also contribute to these findings. Similarly, the improper vaccination leads to injury to nearby structures, which is a well-documented possibility. It is also difficult to assess the main cause of her pain in the settings such as primary health care centers with limited resources where the case was discussed and managed.

However, due to the lack of proper scientific evidence regarding the mechanism and efficacy of serratiopeptidase, it remains unclear whether this enzyme actually has an analgesic effect or simply acts as a placebo in such cases.

Abbreviations

AEFI: adverse events following immunization; NSAIDS: non-steroidal anti-inflammatory drugs; MR: measles-rubella; NRS: numerical rating scale.

Declarations

Ethical Approval and Consent to participate

Not Applicable

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images if any. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Availability of supporting data

Data sharing is not applicable to this article because no datasets were generated or analyzed during the current study.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was not funded.

Authors’ contributions

Ashok P is responsible for the conceptual design and produced the initial draft of the manuscript, which was edited by Arya G. All the authors read and approved the final manuscript.

ACKNOWLEDGEMENT

We thank all the staff members of the Urban Health Promotion Centre, Butwal.

References

[1]   | Bhagat S, Agarwal M, Roy V. Serratiopeptidase: a systematic review of the existing evidence. Int J Surg. 2013; 11(3): 209-217. [PubMed 23380245].
[2]   | D'Souza RM, Campbell-Lloyd S, Isaacs D, et al. Adverse events following immunization associated with the 1998 Australian Measles Control Campaign. Commun Dis Intell. 2000; 24(2): 27-33.
[3]   | Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement Properties of Visual Analog Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review. J Pain. 2019; 20(3): 245-263.
[4]   | John J. Grading of muscle power: comparison of MRC and analog scales by physiotherapists. Medical Research Council. Int J Rehabil Res. 1984; 7(2): 173-81.
[5]   | Mazzone A, Catalani M, Costanzo M, Drusian A, Mandoli A, Russo S, et al. Evaluation of Serratia-peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicenter, double-blind, randomized trial versus placebo. J Int Med Res 1990; 18: 379e88.