Abstract
BackgroundNeuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated.Methodology/Principal FindingsAdult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity.Conclusions/SignificanceOne hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity.
Highlights
Leprosy Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae that principally affects skin and peripheral nerves.[1]
Type 2 or erythema nodosum leprosum (ENL) reactions are associated with immune complex deposition and systemic inflammation is seen with involvement of skin, nerves, eyes, bones and testes
The prevalence of neuropathic pain in treated leprosy patients was higher than expected from clinical practice, but similar to that found in patients with diabetic neuropathy in India (26.1%).[27]
Summary
Leprosy Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae that principally affects skin and peripheral nerves.[1] Leprosy is still present throughout the tropics and subtropics. New nerve damage is treated with steroid therapy, but only about 50% of patients will have improvement in nerve function after a course of steroid treatment.[3] Leprosy is complicated by further episodes of inflammation affecting skin and nerves. These may be Type 1 reactions associated with delayed type hypersensitivity which cause inflammation affecting skin and nerves. The association of neuropathic pain with psychological morbidity was evaluated
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