Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies

Raicher, Irina; Stump, Patrick; Harnik, Simone Bega; Oliveira, Rodrigo Alves de; Baccarelli, Rosemari; Marciano, Lúcia Helena Soares Camargo; Ura, Shogo; Virmond, Marcos; Teixeira, Manoel Jacobsen; Andrade, Daniel Ciampi de

doi:10.1097/pr9.0000000000000638

Cited by 20 publications

(16 citation statements)

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“…In leprosy, the frequency of neuropathic pain ranges from 11.3 to 70.3% [ 12 , 17 , 20 , 27 ]. In our Leprosy Outpatient Clinic based in Rio de Janeiro, the annual prevalence is 15% [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical prediction rules for the diagnosis of neuritis in leprosy

et al. 2021

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Background Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available. Methods In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups (“neuropathic pain” or “neuritis”) by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher’s exact test (p < 0.05). Results Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity. Conclusion This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.

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Section: Introductionmentioning

confidence: 99%

Clinical prediction rules for the diagnosis of neuritis in leprosy

et al. 2021

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“…Tibial nerve neuropathy may be underdiagnosed, as tibial neuritis may develop silently [ 41 ]. Chronic pain is defined as persistent or recurrent for more than or equal to 3 months [ 42 ], and it is known that the neuropathic component in chronic pain impacts more on the quality of life [ 10 ] than pain without the neuropathic component [ 43 ]. All individuals with NP presented chronic pain intermittently or continuously and 93% reported moderate to severe pain.…”

Section: Discussionmentioning

confidence: 99%

“…All individuals with NP presented chronic pain intermittently or continuously and 93% reported moderate to severe pain. These findings show the chronic suffering to which patients are submitted and the lack of diagnosis of NP [ 42 ]. Given that the sampling of this study was randomly obtained, it was not possible to compare individuals with neuropathic and nociceptive pain, which is a limitation of the study.…”

Section: Discussionmentioning

confidence: 99%

Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study

et al. 2021

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Background Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. Methodology/Principal findings This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients’ hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. Conclusion IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.

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“…Pain is rarely recognized as a symptom in leprosy, as leprosy is well known to cause loss of sensation, disability, and disfigurement. Neuropathic pain in leprosy is not routinely investigated in population-based studies; however, recent studies have shown that neuropathic pain can develop several years after the completion of leprosy chemotherapy [45] and the prevalence of pain ranges from 11 to 66%, probably due to differences in study design and clinical setting [45][46][47].…”

Section: Neuropathic Painmentioning

confidence: 99%

“…Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic origin in general. Amitriptyline may be a potential candidate to be tested in clinical drug trials aimed at controlling neuropathic pain in leprosy [46].…”

Section: Neuropathic Painmentioning

confidence: 99%