Diagnosis and medical treatment of neuropathic pain in leprosy

Abstract

Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy

“…In a study in Mumbai, 21% of “released from treatment” (RFT) patients were found to have NP [ 9 ]. Similar studies had been performed in Brazil, Ethiopia, China and Indonesia with findings that more than 20% of patients were reported to have NP [ 9 – 14 , 16 – 23 ]. Due to the differences in screening tools, types of patients studied and study setting, the prevalence of NP in RFT patients varied from 11.3% to 70.3% [ 19 , 21 ].…”

“…In terms of activity limitation, Arco et al found about 90% of leprosy patients with NP had Grade 1 or 2 disability, and there is an association between NP and degree of disability ( p < 0.05) [ 23 ]. Although the Screening of Activity Limitation and Safety Awareness (SALSA) scale has been recommended to measure the degree of limitation imposed by leprosy in daily life activities [ 24 ], only one study in Indonesia applied SALSA in correlation with NP [ 20 ].…”

Work and Leprosy: women in their pains, struggles and toils

“…Pain, in general, constitutes a sensation resulting from unpleasant sensory or emotional experience that may vary between people and is related to the social and cultural context. On the other hand, pain (and its intensity) may also be associated with the representation and meaning that the disease assumes for people affected (19) . One can also think of social pain, one that comes from inequality and social discrimination.…”

“…The overcoming of physical pain can be mitigated by the use of medications (19) ; however, regarding emotional pain, studies show that family support and good follow-up of the health team offer significant support to the person (2) . These aspects are not enough to confront social pain, since they do not touch the basis of production and reproduction of social inequality, they do not debate access to public policies such as education, healthy environment, health, income distribution, among others.…”

“…Physical pain in the person affected by leprosy, as the following statements illustrate, is a common feature and is generally related to the nociceptive stimulus secondary to tissue inflammation or neuropathic cause secondary to damage or dysfunction of the nervous system (19) . Associated with physical pain, we find another form of suffering, which is fear of the reaction of others and shame, which causes people to hide their condition: [ It's difficult for us to talk because it's not everyone who accepts it, there's a prejudice right ...…”