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.
Highlights
Leprosy, known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae (M. leprae)
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
More than one-third of leprosy patients who had completed multidrug therapy, are still suffering from neuropathic pain, and this study demonstrated that it has caused a great impact to their daily activities and psychological status
Summary
Known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). It is characterized by the inflammation of skin and nerve, which could lead to disabling peripheral neuropathy. Since the introduction of multidrug therapy (MDT), leprosy became a treatable disease; and its prevalence decreased globally over the past two decades. It continues to persist as an important public health issue in endemic areas [1]. Leprosy neuropathy, is primarily caused by the infection of Schwann cells by M. leprae which can leave persistent antigen capable of stimulating inflammatory episodes years after cure. Leprosy reactions can affect up to 30–50% of leprosy patients and can, initiate or progress leprosy neuropathy at any time before diagnosis, during treatment, and even years after MDT [3, 4]
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