Investigation of neuropathic pain in treated leprosy patients in Ethiopia: a cross-sectional study.
Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland Department of Dermatology, All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Centre, Addis Ababa, Ethiopia Hand Centre Utrecht, Utrecht, The Netherlands Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland Department of Anaesthetics, Pain Medicine & Intensive Care, Faculty of Medicine, Imperial College, London SW10 9Nh, United Kingdom Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom.
Omer M O
OMO
Haroun
Aki
A
Hietaharju
Elizabeth
E
Bizuneh
Fasil
F
Tesfaye
Wim J
WJ
Brandsma
Maija
M
Haanpää
Andrew S C
ASC
Rice
Diana N J
DNJ
Lockwood
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007918:Leprosy / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult