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

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.

As dores do eu na dor neuropática hansênica: uma leitura psicanalítica do fenômeno subjetivo / / The us pain in hansenic neuropathic pain: a psychoanalytic reading of the subjective phenomenon

O presente trabalho elucida o caso clínico de uma paciente em tratamento na Divisão de Reabilitação do Instituto “Lauro de Souza Lima” por consequência da dor neuropática hansênica em ambos os pés. Essa circunstância a remeteu a condições emocionais e psíquicas de difícil compreensão, a manifestação da dor no corpo passou a apresentar correspondências subjetivas e inconscientes, fazendo emergir com isso sofrimentos psíquicos frente á dor. Sendo assim, tivemos como objetivo geral investigar e compreender as manifestações emocionais presentes no seu discurso, e como específico analisar qual a relação estabelecida entre os processos subjetivos e a presença da dor neuropática. Nossa proposta foi embasada na metodologia de estudo de caso, apoiada no referencial teórico psicanalítico em que se evidenciou uma construção de elementos para uma investigação analítica. Concluímos nesse contexto que ocorreram rupturas nos investimentos narcísicos, no âmbito das relações afetivas, que intensificam a relação conflitiva entre o eu-corpo-dor. E quando esses conteúdos emergem à consciência, proporcionam elaboração psíquica e recursos para lidar com as dores do eu

The present study elucidates the clinical case of a patient undergoing treatment in the Rehabilitation Division of the "Lauro de Souza Lima" Institute due to leprosy neuropathic pain in both feet. This circumstance referred to emotional and psychic conditions of difficult comprehension, the manifestation of pain in the body began to present subjective and unconscious correspondences, thus causing psychic sufferings in the face of pain. Thus, we had as general objective to investigate and understand the emotional manifestations present in his discourse, and how specific to analyze the relationship established between the subjective processes and the presence of neuropathic pain. Our proposal was based on the methodology of a case study, based on the theoretical psychoanalytical framework in which a construction of elements for an analytical investigation was evidenced. We conclude in this context that there are ruptures in narcissistic investments, in the ambit of affective relations that intensify the conflicting relationship between the body-pain-self. And when these contents are presented to the conscious light, they provide psychic elaboration and resources to deal with the pains of the self

Psychological distress and quality of life in leprosy patients with neuropathic pain.

Leprosy is widely known because of progressive damage to the peripheral nerves. In spite of multidrug therapy, some patients develop chronic neuropathic pain after bacteriological cure. Chronic pain is associated with psychological distress and is also an important predictor of poor quality of life. The aim of this study is to assess psychological distress in leprosy patients with chronic neuropathic pain, and its repercussions on their quality of life. The sample of this cross-sectional study comprised patients with chronic neuropathic pain after multidrug therapy. Neuropathic pain was confirmed by clinical examination and by the Douleur neuropathique en 4 questions questionnaire. Pain intensity was assessed using a visual analogic scale (VAS) ruler. The psychological health of the participants was measured using the 12-item General Health Questionnaire, and the WHOQOL-bref was used to assess quality of life. The mean pain intensity reported by participants on the VAS was 7.1 cm (SD = 2.9). No differences in pain intensity with respect to gender were observed. Psychological distress was present in 76.2% of participants, being higher in those with Grade 2 of disability. Patients with psychological distress had the lowest mean scores in all domains of the WHOQOL-bref. The lowest mean scores according to domain were physical (9.9; SD = 3.3), followed by environment (11.9; SD = 3.0), psychological (13.5; SD = 2.6) and social relations (14.0; SD = 3.7). In conclusion, our study identified the presence of psychological distress in most of the participants. Patients with chronic neuropathic pain who were also found to have high psychological distress levels had higher pain intensity and a poorer quality of life.