Poison Center data of 82 patients with bites from Texas coral snakes were analyzed and revealed that most were men, age 18 to 49 years old, bitten on a finger. A skin disruption at the bite site was noted for over 80%, and almost 90% had local swelling, pain, erythema, or paresthesia. Only 7.3% had systemic effects, and none of these were severe. Over half received coral snake antivenin, and 15.9% were given opioids for pain. No patient died and no patient required mechanical ventilation due to hypoventilation from the snakebite. This review of Texas coral snakebites found more severe local findings, and less severe systemic effects than previously reported. Antivenin is not needed for most of these patients, and opioids may be given safely.

The main point I want to make though, is that this paper does not seem to suport the statement that it was cited for: “Texas coral snake…bite produces intense and unremitting pain”. This is what the Morgan et al. say about pain:

Seventy (85.4%, 95% CI: 76.1–91.4%) of the 82 patients had some abnormal finding at the bite site. Thirty-eight patients (46.3%, 95% CI: 36.0–57.1%) noted localized swelling, and 3 (3.7%) had significant swelling. Thirty-five (42.7%, 95% CI: 32.5–53.5%) patients reported some pain, and 13 (15.9%) reported more than mild pain that required multiple doses of medication. This pain frequently radiated up the arm or to the chest. Twenty-four patients (29.3%) were noted to have both pain and swelling, and two patients (2.4%) had both significant pain and significant swelling. Other local findings were erythema, paresthesia, numbness, and a small area of ecchymosis

So only 35% of patients reported any pain only 16% had pain that was severe enough to actually warrant serious analgesics. Morgan et al also note that “Previous studies report minor swelling and no pain.5,10″. They also mention that two cases (of the 37 that did not receive antivenin) had “severe pain”. There is no description in the paper that sounds quite like “intense and unremitting”. Now perhaps that sort of pain does occur, but I don’t see how the authors of the Nature paper know that to be the case. This does not of couse invalidate their findings but it is irritating that they seem to have over dramatized the background information.