Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy.

Autor: Toh HS; Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan., Maharjan J; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Thapa R; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Neupane KD; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Shah M; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Baral S; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Hagge DA; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Napit IB; Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal., Lockwood DNJ; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2018 Jul 02; Vol. 12 (7), pp. e0006610. Date of Electronic Publication: 2018 Jul 02 (Print Publication: 2018).
DOI: 10.1371/journal.pntd.0006610
Abstrakt: Objectives: Neuropathic 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.
Methods: In 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.
Results: 96% 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.
Conclusions: In 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.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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