Understanding the pain experience of lionfish envenomation

Abstract

Introduction: Stings from the lionfish (Pterois volitans) constitute one of the most painful wounds in the ocean. This species has invaded the Atlantic coast of the United States, Gulf of Mexico, Caribbean, and Mediterranean Sea. In addition to its ecological impact on local fish populations, stings from the lionfish pose a medical problem because of the debilitating nature of the pain they produce. However, there are no studies examining the human pain experience of lionfish stings.

Objective: To characterize the various aspects of the pain experience following a lionfish sting.

Methods: We developed a pain questionnaire that includes validated scales used with patients having acute or chronic pain to understand the pain variability, as well as the use of health care resources and treatments.

Results: We provide the first study of the pain experience from lionfish stings. Here, we show that the pain is intense from the start and peaks approximately 1 hour later, resolving itself in 7 days for most victims. Furthermore, pain intensity can be influenced by several factors, including (1) age of the victim, where older victims experience significantly higher pain intensities, (2) the number of spines involved, (3) and whether infection occurred at the injury site. However, pain intensity was not different between male and female participants.

Conclusion: These findings will inform the medical community on the pain experience and can be used by local authorities to better appreciate the impact of lionfish envenomations to develop programs aimed at curtailing the expansion of the lionfish.

Keywords: Envenomation; Lionfish; Pain; Questionnaire; Sting.

Figure 1.

Description of sting survey participants' sex, age and activity they were doing at the time of their lionfish sting. (A) Pie chart depicting distribution of male vs female participants. Number following comma indicates the number of participants. (B) Pie chart depicting age distribution of participants. Number following comma indicates the number of participants. (C) Bar chart demonstrating different activities performed by participants at the time of their lionfish sting.

Figure 2.

Self-reported lionfish pain over the course of 1 week after a sting. Mean (±SD) self-reported pain on 10 immediately after a lionfish sting, 1 hour later, 2 hours later, 1 day later, and 1 week later. (A) Male (441 individuals) vs female (109 individuals) participants. (B) Participants' pain divided based on whether the fish that stung them was alive (477 individuals) or dead (78 individuals). (C) Participants divided based on age range (younger than 30 years: 60 individuals, 30-39 years: 127 individuals, 40-49 years: 116 individuals, 50-59 years: 157 individuals, 60-69 years: 71 individuals, 70-79 years: 24 individuals). All statistical comparisons are relative to younger than 30 years age group, *P < 0.05, **P < 0.01. (D) Participants who have allergies (123 individuals) vs do not have allergies (432 individuals). (E) Participants' pain divided based on how many spines punctured the skin during the sting event (1 spine: 340 individuals, 2 spines: 128 individuals, 3+ spines: 81 individuals, unknown number of spines [not shown]: 5 individuals). ***P < 0.001 (1 spine vs 3 spines). (F) Participants' pain divided based on whether their sting ultimately got infected (infected: 18 individuals, not infected: 537 individuals), *P < 0.05. Mixed model for repeated measures analysis for all panels.