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

Abstract

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.

Author summary

Leprosy could present with chronic neuropathic pain, which might severely disturb daily life and mental health of leprosy-infected patients. This complication could also occur even years after antibiotics therapy completion, and we noticed that it is associated with recent leprosy reactions and nerve tenderness on physical examination. This is the first study that describes the epidemiology of neuropathic pain in leprosy patients in Nepal. More than one-third of leprosy patients who had completed multidrug therapy, are still suffering from neuropathic pain, and this study demonstrated that it has caused a great impact to their daily activities and psychological status. Therefore, prompt recognition and management of neuropathic pain are mandatory while taking care of the patients with leprosy.