Botulinum toxin type A in chronic neuropathic pain in refractory leprosy.

OBJECTIVE: Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. METHODS: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. RESULTS: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. CONCLUSION: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

Botulinum toxin type A in chronic neuropathic pain in refractory leprosy / Toxina Botulínica Tipo A em Dor Neuropática Crônica em Hanseníase

ABSTRACT Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. Objective: To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. Methods: We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Results: Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. Conclusion: BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

RESUMO A dor neuropática é uma síndrome crônica que é difícil de tratar e freqüentemente afeta pacientes com hanseníase. O tratamento recomendado inclui o uso de drogas analgésicas, codeína, antidepressivos tricíclicos, neurolépticos, anticonvulsivantes e talidomida, mas sem consenso sobre dose uniforme e resultados plenamente satisfatórios. Objetivo: Busca-se analisar a efetividade da toxina botulínica tipo A no tratamento da dor neuropática crônica hansênica refratária. Método: Estudo de intervenção do tipo ensaio clínico em portadores de dor neuropática crônica hansênica. Foram coletados dados epidemiológicos, protocolo DN4, escala analógica da dor (EVA), avaliação sensitiva, motora a avaliação do WHOQOL-Bref. Realizado intervenção terapêutica com toxina botulínica tipo A 100U. Os pacientes foram avaliados nos dias de 0, 10 e 60. A dor neuropática foi mais frequente no sexo masculino, na faixa etária de 40 à 49 anos. Resultados: Da forma Dimorfa, multibacilar com baciloscopia positiva e incapacidades presentes. Os escores EVA variam entre 5 e 10, todos os pacientes apresentaram alterações sensoriais. O WHOQOL-Bref apresentou melhora após o tratamento com TxBA. A TxBA foi bem tolerada o único efeito adverso notável foi dor leve. E com apenas uma única aplicação de TxBA promoveu efeitos analgésicos a longo prazo em pacientes com dor associada à alodinia, sugerindo que a analgesia observada pode ser causada por um efeito periférico da TxBA em terminações nociceptivas. Conclusão: O estudo sugere que a TxBA é uma boa opção para os casos de dor neuropática crônica hansênica, no entanto, novos estudos são necessários para confirmar estes resultados.

Peripheral Nerve Stimulation for Painful Mononeuropathy Secondary to Leprosy: A 12-Month Follow-Up Study.

OBJECTIVE: Leprosy affects approximately 10-15 million patients worldwide and remains a relevant public health issue. Chronic pain secondary to leprosy is a primary cause of morbidity, and its treatment remains a challenge. We evaluated the feasibility and safety of peripheral nerve stimulation (PNS) for painful mononeuropathy secondary to leprosy that is refractory to pharmacological therapy and surgical intervention (decompression). METHODS: Between 2011 and 2013 twenty-three patients with painful mononeuropathy secondary to leprosy were recruited to this prospective case series. All patients were considered to be refractory to optimized conservative treatment and neurosurgical decompression. Pain was evaluated over the course of the study using the neuropathic pain scale and the visual analog scale for pain. In the first stage, patients were implanted with a temporary electrode that was connected to an external stimulator, and were treated with PNS for seven days. Patients with 50% or greater pain relief received a definitive implantation in the second stage. Follow-ups in the second stage were conducted at 1, 3, 6, and 12 months. RESULTS: After seven days of trial in the first stage, 10 patients showed a pain reduction of 50% or greater. At 12-month follow-up in the second stage, 6 of the 10 patients who underwent permanent device implantation showed a pain reduction of 50% or greater (75% reduction on average), and two patients showed a 30% reduction in pain. Two patients presented with electrode migration that required repositioning during the 12-month follow-up period. CONCLUSIONS: Our data suggest that PNS might have significant long-term utility for the treatment of painful mononeuropathy secondary to leprosy. Future studies should be performed in order to corroborate our findings in a larger population and encourage the clinical implementation of this technique.

"Even my sister says I'm acting like a crazy to get a check": Race, gender, and moral boundary-work in women's claims of disabling chronic pain.

Recent research examines how women claim chronic pain in response to gendered moral discourses. However, extant research does not explore how race shapes the moral boundary-work performed by women suffering from disabling chronic pain. Through the qualitative analysis of twenty-four semi-structured interviews with women fibromyalgia sufferers conducted between October 2014 and August 2016 in the U.S.A., I demonstrate how women with fibromyalgia claim chronic pain by doing moral boundary-work, referencing gendered and racialized moral discourses that structure how claims of chronic pain as disability are and are not read as legitimate by doctors, disability bureaucrats and personal networks. Extending Hansen et al.'s work on stigma and the "pathologization of poverty," I suggest that, per my sample, the different moral discourses deployed in white and Black women's claims of chronic pain can be explained by the racialized and gendered boundaries of citizenship that structure U.S. welfare and disability politics. Finally, I argue for intersectionality's relevance to research on moral boundary-work and the medicalization of poverty.

Dolor neuropático en pacientes afectados por la lepra / No disponible

Algunos pacientes con lepra pueden sufrir dolor crónico o dolor neuropático, tras el éxito del tratamiento. La prevalencia oscila entre un 17% y un 70% de los antiguos pacientes leprosos. El dolor neuropático se asocia con un deterioro de la calidad de vida de los pacientes y conlleva un elevado agravamiento de la morbilidad psicológica propia de los pacientes con lepra. El manejo de los pacientes con dolor neuropático puede requerir los servicios de salud durante muchos años y un elevado consumo de analgésicos

Some leprosy patients may suffer chronic pain or neuropathic pain after successful treatment. The prevalence ranges between 17% and 70 % of former leprosy patients. Neuropathic pain is associated with deterioration in the quality of life of patients and involves high worsening own psychological morbidity of patients with leprosy. The management of patients with neuropathic pain may require health services for many years and a high consumption of analgesic drugs

Avaliação da S(+)-cetamina no tratamento da dor neuropática e qualidade de vida em portadores de hanseníase / Assessment of the S (+) ketamine in the treatment of neuropathic pain and quality of life in patients with leprosy

A dor neuropática é uma síndrome dolorosa crônica, que ocorre muito frequentemente em pacientes com hanseníase, de difícil tratamento. Objetivou-se avaliar o efeito terapêutico da S(+)-cetamina na dor neuropática e qualidade de vida em portadores de hanseníase atendidos em ambulatórios em São Luís - MA. Estudo experimental tipo ensaio clínico, prospectivo, aleatório, duplamente cego, controlado por placebo, com 34 pacientes distribuídos aleatoriamente em um dois grupos, cetamina e placebo por três meses e randomizados por numeração sequenciada. A dor foi avaliada por meio de escala analógica visual (EAV) nas seis visitas quinzenais (1, 2, 3, 4, 5 e 6), e pelo inventário DN4, na visita 1 e 6, com distribuição da S(+)-cetamina e o analgésico de resgate e avaliado os efeitos adversos em cada visita. Realizou-se a coleta de 15mL de sangue para exames de segurança na visita 1 e 6 e para quantificação de citocinas plasmáticas IL-1, IL-6 e TNFα, nas visitas 1, 2, 4 e 6. Foi também, avaliada a qualidade de vida por meio do questionário WHOQOL-Bref nas visitas 1 e 6. Os resultados demostraram predominância do sexo feminino, idade de 18 a 29 anos, pardos, solteiros, renda de 2 a 4 salários mínimos; e média de 7,78±2,21 anos de estudo. Na avaliação da dor pela EAV os dois grupos apresentaram uma redução dos escores médios de dor ao longo do tempo, e mostrou significância estatística p < 0,05. Entretanto não foi observada diferença estatística para os escores de dor entre os grupos e também, em relação ao uso do medicamento analgésico (codeína) de resgate. Houve redução significante nos escore de DN4 no grupo placebo em relação às avaliações iniciais e finais comparadas à cetamina, ainda os escores iniciais do DN4 foram significativamente menores no grupo placebo, nas avaliações de antes e depois do uso da S(+)-cetamina. Na avaliação da qualidade de vida nos domínios físico, psicológico, relações sociais e meio ambiente, não se observou diferença estatisticamente ...

Neuropathic pain is a chronic pain syndrome of difficult treatment, occurring frequently in patients with leprosy. The objective of this study was to evaluate the therapeutic effect of S(+)-ketamine on neuropathic pain and quality of life in patients with leprosy seen at an outpatient clinic in São Luís - Ma. Experimental study clinical trial, prospective, randomized, double-blind, placebo-controlled trial with 34 patients in a randomized two groups, ketamine and placebo for three months and randomized by sequential numbering. Pain was evaluated using a visual analogue scale (VAS) on six bimonthly visits (1, 2, 3, 4, 5 and 6), and using the DN4 questionnaire on visits 1 and 6, with distribution of S (+)-ketamine and rescue analgesic and adverse effects assessed at each visit. Blood (15ml) was drawn from patients for safety tests on visits 1 and 6, and on visits 1, 2, 4 and 6, to cytokines IL-1, IL-6 and TNFα. Quality of life was also evaluated using WHOQOL-Bref on visits 1 and 6. Results showed most subjects female, age 18 and 29 years of age, pardo ethnicity, single, income between 2 and 4 minimum salaries, and a mean 7.78±2.21 years of education. In the assessment of pain by VAS both groups showed a reduction in mean pain scores over time, and showed statistical significance p <0.05. However there was no statistical difference in pain scores between groups and also in relation to the use of analgesic medication (codeine). There was significant reduction in DN4 score in the placebo group compared to the initial and final evaluations compared to ketamine, although the initial DN4 scores were significantly lower in the placebo group, the assessments before and after the use of S (+)-ketamine. In evaluating the quality of life in the physical, psychological, social relationships and environment, there was no statistically significant difference between groups. The amounts of IL-1, IL-6 and TNF-α in serum of four collections of ketamine and placebo ...