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1.
PLoS Negl Trop Dis ; 16(4): e0010393, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35486667

RESUMO

Leprosy is still a prevalent disease in Brazil, representing 93% of all occurrences in the Americas. Leprosy neuropathy is one of the most worrying manifestations of the disease. Acute neuropathy usually occurs during reaction episodes and is called neuritis. Twenty-two leprosy patients were included in this study. These patients had neural pain associated with ulnar sensory neuropathy, with or without adjunct motor involvement. The neurological picture began within thirty days of the clinical evaluation. The patients underwent a nerve conduction study and the demyelinating findings confirmed the diagnosis of neuritis. Ultrasonographic study (US) of the ulnar nerve was performed in all patients by a radiologist who was blinded to the clinical or neurophysiological results. Morphological characteristics of the ulnar nerve were analyzed, such as echogenicity, fascicular pattern, transverse cross-sectional area (CSA), aspect of the epineurium, as well as their anatomical relationships. The volume of selected muscles referring to the ulnar nerve, as well as their echogenicity, was also examined. Based on this analysis, patients with increased ulnar nerve CSA associated with loss of fascicular pattern, epineurium hyperechogenicity and presence of power Doppler flow were classified as neuritis. Therefore, patients initially classified by the clinical-electrophysiological criteria were reclassified by the imaging criteria pre-established in this study as with and without neuritis. Loss of fascicular pattern and flow detection on power Doppler showed to be significant morphological features in the detection of neuritis. In 38.5% of patients without clinical or neurophysiological findings of neuritis, US identified power Doppler flow and loss of fascicular pattern. The US is a method of high resolution and portability, and its low cost means that it could be used as an auxiliary tool in the diagnosis of neuritis and its treatment, especially in basic health units.


Assuntos
Hanseníase , Neuralgia , Neurite (Inflamação) , Neuropatias Ulnares , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico por imagem , Condução Nervosa , Neurite (Inflamação)/diagnóstico por imagem , Neurite (Inflamação)/etiologia , Nervo Ulnar/diagnóstico por imagem , Neuropatias Ulnares/diagnóstico por imagem , Ultrassonografia
2.
PLoS Negl Trop Dis ; 15(9): e0009794, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34555035

RESUMO

BACKGROUND: Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients' hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. CONCLUSION: IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.


Assuntos
Raios Infravermelhos , Hanseníase/terapia , Neuralgia/terapia , Recidiva , Termografia/métodos , Falha de Tratamento , Adulto , Estudos Transversais , Feminino , , Mãos , Humanos , Hanseníase/complicações , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Neuralgia/complicações , Neuralgia/epidemiologia , Exame Neurológico , Medição da Dor , Prevalência , Termografia/efeitos adversos
3.
BMC Infect Dis ; 21(1): 858, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425777

RESUMO

BACKGROUND: Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available. METHODS: In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups ("neuropathic pain" or "neuritis") by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher's exact test (p < 0.05). RESULTS: Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity. CONCLUSION: This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.


Assuntos
Hanseníase , Neuralgia , Neurite (Inflamação) , Brasil , Regras de Decisão Clínica , Estudos Transversais , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Neurite (Inflamação)/diagnóstico
4.
Biochem Pharmacol ; 192: 114727, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34390739

RESUMO

Thalidomide is an antiinflammatory, antiangiogenic and immunomodulatory agent which has been used for the treatment of erythema nodosum leprosum and multiple myeloma. It has also been employed in treating complex regional pain syndromes. The current study aimed to reveal the molecular mechanisms underlying thalidomide-induced pain antihypersensitive effects in neuropathic pain. Thalidomide gavage, but not its more potent analogs lenalidomide and pomalidomide, inhibited mechanical allodynia and thermal hyperalgesia in neuropathic pain rats induced by tight ligation of spinal nerves, with ED50 values of 44.9 and 23.5 mg/kg, and Emax values of 74% and 84% MPE respectively. Intrathecal injection of thalidomide also inhibited mechanical allodynia and thermal hyperalgesia in neuropathic pain. Treatment with thalidomide, lenalidomide and pomalidomide reduced peripheral nerve injury-induced proinflammatory cytokines (TNFα, IL-1ß and IL-6) in the ipsilateral spinal cords of neuropathic rats and LPS-treated primary microglial cells. In contrast, treatment with thalidomide, but not lenalidomide or pomalidomide, stimulated spinal expressions of IL-10 and ß-endorphin in neuropathic rats. Particularly, thalidomide specifically stimulated IL-10 and ß-endorphin expressions in microglia but not astrocytes or neurons. Furthermore, pretreatment with the IL-10 antibody blocked upregulation of ß-endorphin in neuropathic rats and cultured microglial cells, whereas it did not restore thalidomide-induced downregulation of proinflammatory cytokine expression. Importantly, pretreatment with intrathecal injection of the microglial metabolic inhibitor minocycline, IL-10 antibody, ß-endorphin antiserum, and preferred or selective µ-opioid receptor antagonist naloxone or CTAP entirely blocked thalidomide gavage-induced mechanical antiallodynia. Our results demonstrate that thalidomide, but not lenalidomide or pomalidomide, alleviates neuropathic pain, which is mediated by upregulation of spinal microglial IL-10/ß-endorphin expression, rather than downregulation of TNFα expression.


Assuntos
Interleucina-10/biossíntese , Microglia/metabolismo , Neuralgia/tratamento farmacológico , Neuralgia/metabolismo , Talidomida/uso terapêutico , beta-Endorfina/biossíntese , Animais , Células Cultivadas , Relação Dose-Resposta a Droga , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Interleucina-10/agonistas , Masculino , Microglia/efeitos dos fármacos , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Talidomida/farmacologia , beta-Endorfina/agonistas
5.
J Hand Surg Asian Pac Vol ; 25(4): 407-416, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33115348

RESUMO

Background: Leprous neuropathy is a significant, yet preventable, cause of disability worldwide. Decompressive surgery and oral steroids have been used along with Multi Drug Therapy (MDT) for treating leprous neuropathy with varied success as reported in literature. Methods: We prospectively studied 16 peripheral nerves in 10 patients with leprous neuropathy of less than a year duration and not responding to steroid therapy in 3 weeks. The patients were divided into 2 groups: Group-A (decompressive nerve surgery was done within 12 weeks of onset of neurological deficit), and Group-B (nerve decompression was performed after 12 weeks from onset of neurological deficit). Post-operatively patients were assessed for regression of deformity, sensory, motor, vasomotor recovery and neuropathic pain. Results: Median age of patients was 32 years (range; 18 years to 46 years). Mean motor score and mean grip strength was significantly better for group A patients at 2 years follow-up (p < 0.05). Mean sensory score improved significantly in both the groups (p < 0.05). Similarly, mean VAS score for neuropathic pain improved significantly in both the groups (p < 0.05). Recovery of autonomic function was observed in 3 nerves in group A and 1 in group B. Conclusions: The cases who underwent nerve decompression surgery within 12 weeks had better functional outcomes, especially in terms of motor recovery, than those who were operated after that. Studies involving larger number of patients are required to draw firm conclusions.


Assuntos
Descompressão Cirúrgica , Hanseníase/complicações , Doenças do Sistema Nervoso Periférico/cirurgia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Seguimentos , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/cirurgia , Doenças do Sistema Nervoso Periférico/microbiologia , Estudos Prospectivos , Escala Visual Analógica , Adulto Jovem
6.
Sci Rep ; 10(1): 12648, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32724108

RESUMO

Leprosy, which is caused by the human pathogen Mycobacterium leprae, causes nerve damage, deformity and disability in over 200,000 people every year. Because of the long doubling time of M. leprae (13 days) and the delayed onset of detectable symptoms, which is estimated to be approximately 3-7 years after infection, there is always a large percentage of subclinically infected individuals in the population who will eventually develop the disease, mainly in endemic countries. piRNAs comprise the largest group of small noncoding RNAs found in humans, and they are distinct from microRNAs (miRNAs) and small interfering RNAs (siRNAs). piRNAs function in transposon silencing, epigenetic regulation, and germline development. The functional role of piRNAs and their associated PIWI proteins have started to emerge in the development of human cancers and viral infections, but their relevance to bacterial diseases has not been investigated. The present study reports the piRNome of human skin, revealing that all but one of the piRNAs examined are downregulated in leprosy skin lesions. Considering that one of the best characterized functions of piRNAs in humans is posttranscriptional mRNA silencing, their functions are similar to what we have described for miRNAs, including acting on apoptosis, M. leprae recognition and engulfment, Schwann cell (SC) demyelination, epithelial-mesenchymal transition (EMT), loss of sensation and neuropathic pain. In addition to new findings on leprosy physiopathology, the discovery of relevant piRNAs involved in disease processes in human skin may provide new clues for therapeutic targets, specifically to control nerve damage, a prominent feature of leprosy that has no currently available pharmaceutical treatment.


Assuntos
Transição Epitelial-Mesenquimal , Hanseníase/genética , Hanseníase/patologia , Mycobacterium leprae/patogenicidade , Neuralgia/patologia , RNA Interferente Pequeno/genética , Células de Schwann/patologia , Estudos de Casos e Controles , Doenças Desmielinizantes , Epigênese Genética , Humanos , Hanseníase/microbiologia , Neuralgia/metabolismo , Neuralgia/microbiologia , Células de Schwann/metabolismo , Células de Schwann/microbiologia
7.
Front Immunol ; 11: 23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038662

RESUMO

Pain is a frequent symptom in leprosy patients. It may be predominantly nociceptive, as in neuritis, or neuropathic, due to injury or nerve dysfunction. The differential diagnosis of these two forms of pain is a challenge in clinical practice, especially because it is quite common for a patient to suffer from both types of pain. A better understanding of cytokine profile may serve as a tool in assessing patients and also help to comprehend pathophysiology of leprosy pain. Patients with leprosy and neural pain (n = 22), neuropathic pain (n = 18), neuritis (nociceptive pain) (n = 4), or no pain (n = 17), further to those with diabetic neuropathy and neuropathic pain (n = 17) were recruited at Souza Araujo Out-Patient Unit (Fiocruz, Rio de Janeiro, RJ, Brazil). Serum levels of IL1ß, IL-6, IL-10, IL-17, TNF, CCL-2/MCP-1, IFN-γ, CXCL-10/IP-10, and TGF-ß were evaluated in the different Groups. Impairment in thermal or pain sensitivity was the most frequent clinical finding (95.5%) in leprosy neuropathy patients with and without pain, but less frequent in Diabetic Group (88.2%). Previous reactional episodes have occurred in patients in the leprosy and Pain Group (p = 0.027) more often. Analysis of cytokine levels have demonstrated that the concentrations of IL-1ß, TNF, TGF-ß, and IL-17 in serum samples of patients having leprosy neuropathy in combination with neuropathic or nociceptive pain were higher when compared to the samples of leprosy neuropathy patients without pain. In addition, these cytokine levels were significantly augmented in leprosy patients with neuropathic pain in relation to those with neuropathic pain due to diabetes. IL-1ß levels are an independent variable associated with both types of pain in patients with leprosy neuropathy. IL-6 concentration was increased in both groups with pain. Moreover, CCL-2/MCP-1 and CXCL-10/IP-10 levels were higher in patients with diabetic neuropathy over those with leprosy neuropathy. In brief, IL-1ß is an independent variable related to neuropathic and nociceptive pain in patients with leprosy, and could be an important biomarker for patient follow-up. IL-6 was higher in both groups with pain (leprosy and diabetic patients), and could be a therapeutic target in pain control.


Assuntos
Neuropatias Diabéticas/sangue , Interleucina-1beta/sangue , Interleucina-6/sangue , Hanseníase/sangue , Neuralgia/sangue , Neurite (Inflamação)/sangue , Idoso , Biomarcadores/sangue , Brasil/epidemiologia , Estudos Transversais , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/epidemiologia , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/epidemiologia , Estudos Retrospectivos
9.
Arq Neuropsiquiatr ; 77(5): 346-351, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31188999

RESUMO

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.


Assuntos
Analgésicos/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Dor Crônica/tratamento farmacológico , Hanseníase/tratamento farmacológico , Neuralgia/tratamento farmacológico , Qualidade de Vida , Adulto , Feminino , Humanos , Hanseníase/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Medição da Dor , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
10.
Arq. neuropsiquiatr ; 77(5): 346-351, Jun. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011339

RESUMO

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.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Toxinas Botulínicas Tipo A/uso terapêutico , Dor Crônica/tratamento farmacológico , Analgésicos/uso terapêutico , Hanseníase/tratamento farmacológico , Neuralgia/tratamento farmacológico , Fatores de Tempo , Medição da Dor , Inquéritos e Questionários , Reprodutibilidade dos Testes , Resultado do Tratamento , Hanseníase/fisiopatologia , Fármacos Neuromusculares/uso terapêutico
11.
Trans R Soc Trop Med Hyg ; 113(12): 813-817, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715525

RESUMO

The chronic aspects of leprosy are discussed here. They are a consequence of the peripheral nerve damage that affects many patients during their lifetime with leprosy. The peripheral nerve damage leaves people unable to feel and with weakness in their hands and feet. They are at risk of damaging their hands and feet, causing the disabilities and deformities that characterise late leprosy. More than 200 000 new leprosy patients are diagnosed globally each year. Better data are needed from cohort studies to estimate the number of patients developing nerve damage and modelling studies are needed to estimate the number of patients who develop disabilities. For some of them, this will be a lifelong disability. Nerve damage is caused by inflammation in leprosy-affected nerves. Patients with nerve damage of <6-mo duration need treatment with steroids. About 66% of multibacillary patients will develop nerve damage. Plastic graded monofilaments can be used to detect nerve damage in leprosy and diabetic clinics. Assessing nerve damage and treating patients with steroids in leprosy programmes needs to be strengthened. The World Health Organization has a successful programme for supplying antibiotics for treating leprosy infection to national leprosy programmes. They should take responsibility for providing steroids to national programmes since this is a core part of the treatment for >66% of multibacillary patients. Patients need to be asked about neuropathic pain symptoms and treated if necessary. Treated leprosy patients are at risk of developing ulcers in their feet. Treatment and prevention needs to be improved through health education, providing protective footwear and patient empowerment.


Assuntos
Hanseníase/complicações , Doenças Negligenciadas/complicações , Doença Crônica , Avaliação da Deficiência , Eritema Nodoso/microbiologia , Humanos , Hanseníase/diagnóstico , Hanseníase/economia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/economia , Doenças do Sistema Nervoso/microbiologia , Neuralgia/microbiologia , Transtornos das Sensações/microbiologia , Estigma Social
13.
PLoS Negl Trop Dis ; 12(7): e0006610, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29965957

RESUMO

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.


Assuntos
Hansenostáticos/administração & dosagem , Hanseníase/complicações , Neuralgia/etiologia , Adulto , Idoso , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Neuralgia/epidemiologia , Neuralgia/psicologia , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
14.
Am J Trop Med Hyg ; 98(6): 1609-1613, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29611495

RESUMO

Neural pain is a frequent symptom in leprosy disease. There is a paucity of data regarding neural pain diagnostics resulting in common prescriptive errors when neuritis is confused with neuropathic or mixed nociceptive-neuropathic pain. The present study identified important demographic, clinical, and neurophysiological features of 42 leprosy neuropathy patients presenting neuropathic pain (NP). During routine evaluations, patients were selected asking if they had ever experienced neural pain. Data analyses of their pain characteristics, clinical examination results, and both the Douleur Neuropathique 4 Questionnaire and Hamilton Depression Scale scores were used to classify these patients. The most common word they used to describe the sensation of pain for 25 (60%) of these patients was "burning." In the early stages of the disease and before leprosy diagnosis, 19 (45%) had already complained about NP and leprosy treatment was unable to prevent its occurrence in 15 (36%). Leprosy reactions, considered NP risk factors, occurred in 32 (76%) cases. Knowledge of typical NP characteristics could be used to develop more effective therapeutic approaches for a notoriously difficult-to-treat pain condition.


Assuntos
Hanseníase/complicações , Neuralgia/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Hanseníase Multibacilar/complicações , Hanseníase Multibacilar/epidemiologia , Hanseníase Multibacilar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/epidemiologia , Transtornos Motores/etiologia , Condução Nervosa/fisiologia , Neuralgia/epidemiologia , Neuralgia/etiologia , Dor , Medição da Dor , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Adulto Jovem
15.
Front Immunol ; 9: 463, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29593724

RESUMO

Leprosy remains as a public health problem and its physiopathology is still not fully understood. MicroRNAs (miRNA) are small RNA non-coding that can interfere with mRNA to regulate gene expression. A few studies using DNA chip microarrays have explored the expression of miRNA in leprosy patients using a predetermined set of genes as targets, providing interesting findings regarding the regulation of immune genes. However, using a predetermined set of genes restricted the possibility of finding new miRNAs that might be involved in different mechanisms of disease. Thus, we examined the miRNome of tuberculoid (TT) and lepromatous (LL) patients using both blood and lesional biopsies from classical leprosy patients (LP) who visited the Dr. Marcello Candia Reference Unit in Sanitary Dermatology in the State of Pará and compared them with healthy subjects. Using a set of tools to correlate significantly differentially expressed miRNAs with their gene targets, we identified possible interactions and networks of miRNAs that might be involved in leprosy immunophysiopathology. Using this approach, we showed that the leprosy miRNA profile in blood is distinct from that in lesional skin as well as that four main groups of genes are the targets of leprosy miRNA: (1) recognition and phagocytosis, with activation of immune effector cells, where the immunosuppressant profile of LL and immunoresponsive profile of TT are clearly affected by miRNA expression; (2) apoptosis, with supportive data for an antiapoptotic leprosy profile based on BCL2, MCL1, and CASP8 expression; (3) Schwann cells (SCs), demyelination and epithelial-mesenchymal transition (EMT), supporting a role for different developmental or differentiation gene families, such as Sox, Zeb, and Hox; and (4) loss of sensation and neuropathic pain, revealing that RHOA, ROCK1, SIGMAR1, and aquaporin-1 (AQP1) may be involved in the loss of sensation or leprosy pain, indicating possible new therapeutic targets. Additionally, AQP1 may also be involved in skin dryness and loss of elasticity, which are well known signs of leprosy but with unrecognized physiopathology. In sum, miRNA expression reveals new aspects of leprosy immunophysiopathology, especially on the regulation of the immune system, apoptosis, SC demyelination, EMT, and neuropathic pain.


Assuntos
Regulação da Expressão Gênica/imunologia , Hanseníase , MicroRNAs , Neuralgia , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos , Hanseníase/sangue , Hanseníase/genética , Hanseníase/imunologia , Masculino , MicroRNAs/sangue , MicroRNAs/genética , MicroRNAs/imunologia , Pessoa de Meia-Idade , Neuralgia/sangue , Neuralgia/genética , Neuralgia/imunologia
16.
Neuromodulation ; 21(3): 310-316, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29082637

RESUMO

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.


Assuntos
Terapia por Estimulação Elétrica/métodos , Hanseníase/complicações , Mononeuropatias/etiologia , Neuralgia/terapia , Manejo da Dor/métodos , Dor Crônica/etiologia , Dor Crônica/terapia , Feminino , Seguimentos , Humanos , Masculino , Neuralgia/etiologia , Resultado do Tratamento
17.
s.l; s.n; 2018. 7 p. tab.
Não convencional em Inglês | SES-SP, SES-SP, HANSEN, HANSENIASE, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1023341

RESUMO

Introduction: Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in "pharmacologically cured" patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient's quality of life, daily activities, and mood.Objectives: The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy. Methods: Leprosy and nonleprosy patients had their neuropathic pain characterized by the neuropathic pain symptom inventory (NPSI, ranges from 0 to 100, with 100 being the maximal neuropathic pain intensity) in a first visit. In a second visit, leprosy patients who had significant pain and received pharmacological treatment in the first evaluation were reassessed (NPSI) and had their pain profile and treatment response further characterized, including information on drugs prescribed for neuropathic pain and their respective pain relief. Results: The pain characteristics based on NPSI did not significantly differ between leprosy and nonleprosy neuropathic pain patients in visit 1 after correction for multiple analyses, and cluster analyses confirmed these findings (ie, no discrimination between leprosy and nonleprosy groups; Pearson x2 5 0.072, P 5 0.788). The assessment of pain relief response and the drugs taken by each patient, linear regression analysis showed that amitriptyline, when effective, had the highest percentage of analgesic relief. Conclusions: Neuropathic pain in leprosy is as heterogeneous as neuropathic pain of other etiologies, further supporting the concept that neuropathic pain is a transetiological entity. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile in general, and amitriptiline may constitute a potential candidate drug for future formal clinical trials aimed at controlling neuropathic pain in leprosy.


Assuntos
Humanos , Hanseníase/complicações , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/tratamento farmacológico , Amitriptilina/uso terapêutico , Amitriptilina/farmacologia
18.
Bauru; s.n; 2018. 18 p.
Não convencional em Português | SES-SP, SES-SP, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP, SESSP-PAPSESSP, SES-SP | ID: biblio-1085520

RESUMO

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


Assuntos
Humanos , Feminino , Idoso , Hanseníase/complicações , Hanseníase/psicologia , Neuralgia/psicologia , Nervos Periféricos/patologia , Teoria Psicanalítica
19.
Rev Lat Am Enfermagem ; 24: e2731, 2016 08 08.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-27508904

RESUMO

OBJECTIVE: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. METHODS: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. RESULTS: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). CONCLUSION: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.


Assuntos
Hanseníase/complicações , Neuralgia/diagnóstico , Neuralgia/terapia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
20.
Am J Trop Med Hyg ; 95(4): 756-759, 2016 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-27458041

RESUMO

Neuropathic pain (NP) often occurs during the course of leprosy, and screening tools to differentiate NP from non-NP are often used. However, their performance varies in different settings. The most frequently used scales are the Douleur Neuropathique in 4 questions (DN4) and the Leeds assessment of neuropathic symptoms and signs (LANSS) questionnaires. Thus, we conducted a study to evaluate the agreement between DN4 and LANSS questionnaires to classify NP in 195 leprosy patients attending two reference centers in Sergipe, Brazil. The DN4 and LANSS classified 166 and 110 patients, respectively, as having NP. One hundred and seven (54.8%) were classified as NP by both questionnaires; 59 (30.2%) solely by the DN4 questionnaire and three (1.5%) solely by the LANSS. The agreement of the questionnaires was 66.2% (weak agreement, Kappa = 0.30). Although both questionnaires identified a high proportion of NP, the development of more robust instruments is necessary to ensure the accuracy of diagnosis of leprosy patients classified as having NP.


Assuntos
Hanseníase/complicações , Neuralgia/classificação , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Reprodutibilidade dos Testes , Inquéritos e Questionários
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