Acute and chronic pain associated with leprosy

Thakur, Siddarth; Dworkin, Robert H.; Haroun, Omer M.O.; Lockwood, Diana N J; Rice, Andrew S.C.

doi:10.1097/j.pain.0000000000000178

Cited by 14 publications

(14 citation statements)

References 32 publications

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“…2). The most clinically important painful generalized peripheral neuropathies include those associated with diabetes mellitus (BOX 3), pre-diabetes and other metabolic dysfunctions, infectious diseases (mainly HIV infection 28 and leprosy 29 ), chemotherapy, immune (for example, Guillain-Barre syndrome) and inflammatory disorders, inherited neuropathies and channelopathies (such as inherited erythromelalgia, a disorder in which blood vessels are episodically blocked then become hyperaemic and inflamed).…”

Section: Mechanisms/pathophysiologymentioning

confidence: 99%

Neuropathic pain

Colloca

Ludman

Bouhassira

et al. 2017

Nat Rev Dis Primers

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Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7–10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.

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Section: Mechanisms/pathophysiologymentioning

confidence: 99%

Neuropathic pain

Colloca

Ludman

Bouhassira

et al. 2017

Nat Rev Dis Primers

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1,573

1,364

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“…Some of this burden is probably attributable to neuropathic pain, which chronically afflicts some 20% to 25% of leprosy patients even long after mycobacteriological cure because of persisting nerve damage and new immune-mediated neuritis reactions. 13,18,24 Overall, cancer accounted for 6.8 million YLDs, an increase of 83% (age-adjusted 8.5 million YLDs). Neuropathic or mixed pain has been found to affect 20% to 40% of people with cancer.…”

Section: The Burden Of "Hidden" Painmentioning

confidence: 99%

Pain and the global burden of disease

Rice

Smith

Blyth

2016

Pain

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“…4,8,9,16,17 These estimates are likely to vary by the type of participants and the diagnostic tools used. 9 The DN4 questionnaire is reported to have high sensitivity (100%) 4 but variable specificity (45-92%) [4][5][6]18 ; whereas the LANSS questionnaire is reported to have slightly lower sensitivity (85%) and specificity (42%). 4 Although screening tools offer screening guidance for the potential presence of NP, their use should not replace clinical judgment, which is considered the reference standard by experienced clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 There is also a well-established association between the presence of leprosy reactions and pain, 4,9 and it is presumed that NP develops gradually as a consequence of the regenerative processes leading to overactive peripheral nociceptive fibers resulting from chronic neural inflammation. 4 The main limitation of this study therefore concerns with sample selection, as participants were attending reference centers and were more likely to have NP than patients attending primary care facilities.…”

Section: Discussionmentioning

confidence: 99%

“…4 Between 11% and 79% of patients with leprosy are reported to have NP [4][5][6][7][8] ; and other types of pain, such as nociceptive and inflammatory pain may occur. 9 The proper classification of pain is essential for the selection of therapy, as nociceptive pain responds to steroids and anti-inflammatory drugs 10 ; inflammatory pain can be treated with nonsteroidal anti-inflammatory drugs, 9 and NP responds to tricyclic antidepressants, anticonvulsants, and opioids. 11 Although NP is a common complication of leprosy, its identification is often neglected.…”

Section: Introductionmentioning

confidence: 99%

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Agreement Between the Douleur Neuropathique in 4 Questions and Leeds Assessment of Neuropathic Symptoms and Signs Questionnaires to Classify Neuropathic Pain Among Patients with Leprosy

Santana

Santos

Gurgel

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Neuropathic pain (NP) often occurs during the course of leprosy, and screening tools to differentiate NP from non-NP are often used. However, their performance varies in different settings. The most frequently used scales are the Douleur Neuropathique in 4 questions (DN4) and the Leeds assessment of neuropathic symptoms and signs (LANSS) questionnaires. Thus, we conducted a study to evaluate the agreement between DN4 and LANSS questionnaires to classify NP in 195 leprosy patients attending two reference centers in Sergipe, Brazil. The DN4 and LANSS classified 166 and 110 patients, respectively, as having NP. One hundred and seven (54.8%) were classified as NP by both questionnaires; 59 (30.2%) solely by the DN4 questionnaire and three (1.5%) solely by the LANSS. The agreement of the questionnaires was 66.2% (weak agreement, Kappa = 0.30). Although both questionnaires identified a high proportion of NP, the development of more robust instruments is necessary to ensure the accuracy of diagnosis of leprosy patients classified as having NP.

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Acute and chronic pain associated with leprosy

Cited by 14 publications

References 32 publications

Neuropathic pain

Neuropathic pain

Pain and the global burden of disease

Agreement Between the Douleur Neuropathique in 4 Questions and Leeds Assessment of Neuropathic Symptoms and Signs Questionnaires to Classify Neuropathic Pain Among Patients with Leprosy

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