Pain and quality of life in leprosy patients in an endemic area of Northeast Brazil: a cross-sectional study

Abstract

BackgroundPain emerges as a challenge in the treatment of leprosy patients. In this study, we describe the prevalence and type of pain in patients with leprosy, and its effect on patients’ quality of life in an endemic area of Northeast Brazil.FindingsA cross-sectional survey of 260 patients attending leprosy reference centres in Sergipe, Northeast Brazil was conducted. Individuals were assessed for the presence and type of pain, skin sensory loss, peripheral nerve enlargement, touch and pinprick sensations, mechanical allodynia and nerve palpation. Participants completed the Douleur Neuropathique 4 questionnaire, and we also used the Brief Pain Inventory scale and the World Health Organization Quality of Life-BREF instrument to arrive at our results. One hundred and ninety-five (75 %) patients reported pain, mostly of the neuropathic type. Pain was moderate in 84 (43.1 %) and severe in 94 (48.2 %) participants. The presence of pain was associated with disability (p = 0.001), leprosy reactions (p = 0.004) and lower quality of life. Most patients with neuropathic pain were treated with steroids, despite their low efficacy for this type of pain.ConclusionPain is highly prevalent among leprosy patients and is associated with low quality of life. Leprosy management should include a systematic assessment of the type of pain a patient experiences in order to provide adequate treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0113-1) contains supplementary material, which is available to authorized users.

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

“…The reported prevalence of NP in leprosy patients, however, varies widely. 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%).…”

“…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.…”

“…1 Neuropathic pain (NP), or "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system," 2 is present in 1-18% of patients with pain 3 and occurs in a wide range of diseases. 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.…”

Epidemiological Characteristics of Leprosy and the Effects of its Control in Chongqing, China, 1949-2018

“…It has been reported that the quality of life of patients with functional limitations is adversely affected in both physical health and environmental domains. In addition, sequelae caused by leprosy, such as disability and nerve damage, are major risk factors for Parkinson's disease [26][27][28][29]. Therefore, in the future, the city should improve the early detection of leprosy, strengthen prevention and treatment efforts, reduce the incidence of disability in patients, and eliminate the harm of leprosy [30].…”

Factors Affecting Body Image and Self-Esteem in Leprosy Patients and Comparison to Healthy Individuals

“…7 Benlik saygısı ve beden imajı seviyelerinin, kişinin hastalıklara karşı gösterdiği direnci etkilediği, benlik saygısı ve beden imajı yeterli düzeyde olmayan kişilerin tedaviye yeterince yanıt vermediği görülmüştür. 8 Bununla birlikte, kişinin bedeninde oluşan şekil bozuklukları ya da oluşan fiziksel değişimler beden imajını etkileyerek kişide yetmezlik duygusu yarattığı, bunun sonucunda benlik saygısının azaldığı saptanmıştır. Bu hastalığın tedavisinin uzun sürmesi, ilaç kullanımının zorluğu, kişinin sosyokültürel düzeyi ve benlik saygısı, tedaviye uyumu önemli ölçüde etkilemektedir.…”