The association between neuropathic pain and disability grades in leprosy

Abstract

To detect neuropathic pain in people who have had leprosy and correlate this association with the WHO Degree of Physical Disability classification (DPD-WHO). Data were collected from medical records, interviews and physical examinations of patients treated in 2013 in a regional referral service that attends 102 municipals. Clinical and general data, the DPD-WHO classification and the Douleur Neuropathique 4 Questionnaire (DN4) were utilised to determine the profile and to diagnose neuropathic pain. Of 84 treated patients, 37 (44.1%) had leprosy-related pain at the time of the interview. The mean age was 53 years, 51.4% were women; 75.7% had multibacillary disease and 72.9% had some kind of reactional episode. Of the 37 patients with pain, 22 (59.5%) had neuropathic pain and 15 (40.5%) had nociceptive pain. The most frequently reported symptoms related to neuropathic pain, apart from numbness (64.9%), were tingling and touch hypoesthesia (56.8%). Of 22 patients with neuropathic pain, 20 had some physical disability; 14 (63.6%) had Grade I disability, six (27.2%) Grade II, and two (9.3%) Grade zero disability. An association was found between neuropathic pain and degree of disability (P-value < 0.05). Of the patients who reported pain related to leprosy, 59.5% had neuropathic pain. The DN4 seems to be suitable for determining the presence of neuropathic pain in leprosy. There is an association between the degree of disability and neuropathic pain, i.e. patients with neuropathic pain tend to have a physical disability too.