Diagnosis and medical treatment of neuropathic pain in leprosy

Arco, Rogerio Del; Nardi, Susilene Maria Tonelli; Bassi, Thiago Gasperini; Paschoal, Vania Del Arco

doi:10.1590/1518-8345.0676.2731

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 24 • 2016 • https://doi.org/10.1590/1518-8345.0676.2731 copy

Diagnosis and medical treatment of neuropathic pain in leprosy^¹ 1 Paper extrated from Master's Thesis "Diagnóstico e tratamento da dor neuropática em pacientes tratados de hanseníase", presented to Faculdade de Medicina de São José do Rio Preto, São Jose do Rio Preto, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Descriptors:
Leprosy; Neurologic Manifestations; Disabled Persons; Pain

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Vania Del Arco Paschoal FAMERP. Departamento Enfermagem Saúde Coletiva Av. Faria Lima, 5416 Vila São Pedro CEP: 15.090-000, São José do Rio Preto, SP, Brasil E-mail: vaniapaschoal@yahoo.com.br

General Characteristics of the patients with neuropathic pain (N=22)		N	%
Gender	Male	8	36.3
Gender	Female	14	63.7
Classification of the treatment by the WHO*	Paucibacillary	7	31.9
Classification of the treatment by the WHO*	Multibacillary	15	68.1
Time of the diagnosis for leprosy	<5 years	8	36.3
Time of the diagnosis for leprosy	>5 years	14	63.7
Time when the polychemotherapy ends	<1 year	5	22.7
	1 to 5 years	6	27.3
	>5 years	11	50
Previous history of reactionary state	Yes	11	50
Previous history of reactionary state	No	11	50
Time of the first symptons	<6 months	4	18.2
Time of the first symptons	>6 months	18	81.8
Characteristics of the first symptons	Sudden	1	4.6
Characteristics of the first symptons	Gradual	21	95.4
Intensity of pain - NRS^†	Lighht (1 to 3)	2	9.1
	Moderate (4 to 6)	15	68.2
	Severe (7 to10)	5	22.7
Pattern of the pain	Superficial	Zero	Zero
	Deep	17	77.3
	Both	5	22.7
Level of incapacity - WHO*	Zero	2	9.2
	Level 1	14	63.6
	Level 2	6	27.2

Characteristics of the diagnosis and treatment of patients with neuropathic pain	Situation	n	%
Diagnosed for neuropathic pain (n=22)	Yes	12	54.5
	No	10	45.5
Specialist that carried out the diagnosis (n=12)	Dermatologist	8	66.6
	Neurologist	4	33.4
Response to the treatment (n=12)	Improvements in the pain	5	41.6
	Equal or worse	7	58.4
Type of medication used in the treatment (n=12)	Monotherapy	4	33.4
	Polytherapy	8	66.6
Causes for failures in the therapy used (n=7)	Stopped due to side effects	3	42.9
	Unaware of the medication	1	14.3
	Taking inadequate doses	2	28.5
	Lack of polytherapy	1	14.3
The way how the medication was acquired (n=12)	Government	10	83.3
	Government + Private Sector	2	16.7

Variables	Treated (n=12)	Non treated (n=10)	Value of p
Improvements in the pain	5	0	0.0202*
Intensity of pain - (average)	7.5	6	0.4652^†
*Points on the Douler Neuropathic 4 Questionary questionnaire (average)	7	6.5	0.0692^†

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Diagnosis and medical treatment of neuropathic pain in leprosy1 1 Paper extrated from Master's Thesis "Diagnóstico e tratamento da dor neuropática em pacientes tratados de hanseníase", presented to Faculdade de Medicina de São José do Rio Preto, São Jose do Rio Preto, SP, Brazil.

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Diagnosis and medical treatment of neuropathic pain in leprosy^¹ 1 Paper extrated from Master's Thesis "Diagnóstico e tratamento da dor neuropática em pacientes tratados de hanseníase", presented to Faculdade de Medicina de São José do Rio Preto, São Jose do Rio Preto, SP, Brazil.