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

Abstract

ObjectivesNeuropathic pain (NP) can occur as a chronic complication of leprosy neuropathy. NP epidemiology and its impact on patients have not been well documented. This study investigates NP prevalence and impact in the years after patients are declared “released from treatment” (RFT) following multidrug therapy (MDT) completion.MethodsIn this cross-sectional study, 85 RFT patients were recruited within leprosy referral services in Nepal. The Douleur Neuropathique 4 Questionnaire (DN4) was used to screen for NP. Pain severity, impacts on patients’ daily activities and mental health were measured by using the Brief Pain Inventory (BPI), Screening of Activity Limitation and Safety Awareness (SALSA), and General Health Questionnaire-12 (GHQ-12) respectively.Results96% surveyed had been treated for multibacillary leprosy. 44 (52%) complained of pain of which 30 (68%) were diagnosed with NP. NP was not associated with age, gender, or presence of skin lesions or nerve symptoms at leprosy diagnosis. 70% of patients with NP had either history of or ongoing reactions and 47% had grade 2 disability. Nerve tenderness (p = 0.023) and current reactions (p = 0.018) were significant risk factors for NP. Patients with NP suffered significantly higher intensity pain (p = 0.023) and daily life interference (p = 0.003) and were more likely to have moderate to extreme daily activity limitations (p = 0.005). 13 (43%) exhibited psychological distress, and medications only reduced moderate degree (50–60%) of pain.ConclusionsIn our study, 35% of RFT patients had ongoing NP. Risk factors include nerve tenderness and reaction. They suffer from more daily life interference and psychological distress. Leprosy patient care should include recognition and management of NP.

The use of integrative and complementary practices in leprosy-related pain is influenced by sociodemographic, clinical and care factors: A case-control study

“…The frequency of pain in patients with leprosy is high, and can reach more than 70% of this population. Nociceptive pain is present in approximately 10% of individuals (Santos et al, 2016), and neuropathic pain can affect more than half of this population, which can occur even years after the completion of treatment (Toh et al, 2018).…”

“…The presence of pain unconsciously generates changes in vital signs, stress and anxiety in the patient (Dik & Lohmann, 2020). Therefore, people with leprosy pain suffer daily physical restrictions that impact their quality of life (Santos et al, 2016;Toh et al, 2018).…”

Exploring the Promise of Flavonoids to Combat Neuropathic Pain: From Molecular Mechanisms to Therapeutic Implications

“…Paresthesia (i.e., aberrant sensations of the skin including tingling, chilling, numbness, burning, and pricking), spontaneous or shooting stimulus-independent pain, as well as electric shock-like sensations are involved in spontaneous positive symptoms; whereas, stimulus-induced positive symptoms of neuropathy include allodynic and hyperalgesia pain (Rasmussen et al, 2004;Beran, 2015). On the other hand, hypoesthesia (i.e., decreased sensations to non-painful stimuli), hypoalgesia (i.e., decreased sensations to toxic stimuli), pallhypesthesia (i.e., decreased sensations to vibration), and thermohypoesthesia (i.e., decreased sensations to cold/warm stimuli) are negative symptoms of NP (Jensen and Baron, 2003;Toh et al, 2018).…”

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“…Other prevalence factor of NP is the presence of LR, mainly type II reactions. In addition, even the full therapy was unable to treat NP, which affects patients' quality of life and mental health moderately to intensely 8,9,10 .…”