Chronic neuropathic pain emerges as a challenge in the treatment of leprosy patients after multidrug therapy discharge. The aim of this study was to determine the quality of life and its repercussions in leprosy patients with chronic pain. We studied male and female patients with chronic neuropathic pain in the last year. Neuropathic pain was confirmed using Douleur Neuropathique en 4 (DN4) and its intensity evaluated by visual analogue scale (VAS). A general questionnaire was applied to evaluate quality of life (WHOQOL-bref). Statistical analyses were composed by descriptive and central tendency. Spearman correlation was used to identify the relation between pain intensity, quality of life domains, and facets. Multiple linear regressions were performed to verify the influence of pain intensity on each facet. Neuropathic pain patients scored worst in physical and environment domains. The low facets were related to pain and discomfort, thinking and concentration, sexual activity, and recreation opportunities. Pain intensity has a high negative influence on psychological domain and recreation opportunities. These findings should contribute to the development of rehabilitation programs considering patients needs to improve their quality of life and true social reintegration. 1. Introduction Leprosy is a chronic granulomatous infection, principally affecting the skin and peripheral nerves, caused by Mycobacterium leprae [1]. Neuropathic pain is a common complaint due to leprosy-induced neuritis, whether spontaneous or upon palpation of a nerve trunk (silent neuritis), which may be associated with impairment of function [1–6]. In addition to not knowing the precise number of patients who develop disabilities after multidrug therapy (MDT), chronic pain arises as a new disabling condition during or after bacteriological treatment [7–12]. The International Association for the Study of Pain (IASP) defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system [13, 14]. According to new theories, pain is a subjective experience influenced by a combination of cortical mechanisms [15]. It is widely believed that pain has a profound effect on a person’s quality of life (QoL). Considering that leprosy causes sensory loss, it was expected that patients do not experience pain, and it has not been well studied in leprosy [10]. Therefore, a lack of
References
[1]
L. C. Rodrigues and D. N. J. Lockwood, “Leprosy now: epidemiology, progress, challenges, and research gaps,” The Lancet Infectious Diseases, vol. 11, no. 6, pp. 464–470, 2011.
[2]
C. K. Job, “Pathology and pathogenesis of leprous neuritis; a preventable and treatable complication,” International Journal of Leprosy and Other Mycobacterial Diseases, vol. 69, supplement 2, pp. S19–S29, 2001.
[3]
S. L. Walker and D. N. J. Lockwood, “Leprosy,” Clinics in Dermatology, vol. 25, no. 2, pp. 165–172, 2007.
[4]
D. Porichha, A. Mukherjee, and G. Ramu, “Neural pathology in leprosy during treatment and surveillance,” Leprosy Review, vol. 75, no. 3, pp. 233–241, 2004.
[5]
P. G. Nicholls, R. P. Croft, J. H. Richardus, S. G. Withington, and W. C. S. Smith, “Delay in presentation, an indicator for nerve function status at registration and for treatment outcome—the experience of the Bangladesh Acute Nerve Damage Study cohort,” Leprosy Review, vol. 74, no. 4, pp. 349–356, 2003.
[6]
M. I. Fernandes Pimentel, R. Rolo, J. A. Da Costa Nery, E. Nunes Sarno, and E. Borges, “Silent neuritis in multibacillary leprosy evaluated through the development of disabilities before, during and after multidrug therapy,” Anais Brasileiros de Dermatologia, vol. 79, no. 2, pp. 169–179, 2004.
[7]
G. N. Malaviya, “Neuropathic pain in leprosy patients,” International Journal of Leprosy and Other Mycobacterial Diseases, vol. 73, no. 1, pp. 34–35, 2005.
[8]
P. R. Stump, R. Baccarelli, L. H. Marciano, et al., “Neuropathic pain in leprosy patients,” International Journal of Leprosy and Other Mycobacterial Diseases, vol. 72, no. 2, pp. 134–138, 2004.
[9]
R. Croft, “Neuropathic pain in leprosy,” International Journal of Leprosy and Other Mycobacterial Diseases, vol. 72, no. 2, pp. 171–172, 2004.
[10]
M. Haanp？？, D. N. J. Lockwood, and A. Hietaharju, “Neuropathic pain in leprosy,” Leprosy Review, vol. 75, no. 1, pp. 7–18, 2004.
[11]
P. Saunderson, E. Bizuneh, and R. Leekassa, “Neuropathic pain in people treated for multibacillary leprosy more than ten years previously,” Leprosy Review, vol. 79, no. 3, pp. 270–276, 2008.
[12]
F. J. Reis, L. M. Saadi, M. K. Gomes, A. P. Gosling, and A. J. Cunha, “Pain in leprosy patients: shall we always consider as a neural damage?” Leprosy Review, vol. 82, no. 3, pp. 319–321, 2011.
[13]
J. J. Bonica, “General considerations of chronic pain,” in The Management of Pain, J. J. Bonica, Ed., Lea and Febiger, Philadelphia, Pa, USA, 1990.
[14]
D. C. Turk and T. E. Rudy, “Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data,” Journal of Consulting and Clinical Psychology, vol. 56, no. 2, pp. 233–238, 1988.
[15]
G. L. Moseley, “A pain neuromatrix approach to patients with chronic pain,” Manual Therapy, vol. 8, no. 3, pp. 130–140, 2003.
[16]
J. G. Santos, J. O. Brito, D. C. de Andrade et al., “Translation to Portuguese and validation of the douleur neuropathique 4 questionnaire,” Journal of Pain, vol. 11, no. 5, pp. 484–490, 2010.
[17]
E. Lasry-Levy, A. Hietaharju, V. Pai, et al., “Neuropathic pain and psychological morbidity in patients with treated leprosy: a cross-sectional prevalence study in Mumbai,” PLOS Neglected Tropical Diseases, vol. 5, no. 3, p. e981, 2011.
[18]
M. Briggs and J. S. Closs, “A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients,” Journal of Pain and Symptom Management, vol. 18, no. 6, pp. 438–446, 1999.
[19]
M. P. A. Fleck, S. Louzada, M. Xavier et al., “Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref,” Revista de Saude Publica, vol. 34, no. 2, pp. 178–183, 2000.
[20]
M. P. A. Fleck, S. Louzada, M. Xavier et al., “Application of the Portuguese version of the instrument for the assessment of the quality of life of the World Health Organization (WHOQOL-100),” Revista de Saude Publica, vol. 33, no. 2, pp. 198–205, 1999.
[21]
W. H. van Brakel, “Disability and leprosy: the way forward,” Annals of the Academy of Medicine Singapore, vol. 36, no. 1, pp. 86–87, 2007.
[22]
H. Cross, “The prevention of disability for people affected by leprosy: whose attitude needs to change?” Leprosy Review, vol. 78, no. 4, pp. 321–329, 2007.
[23]
A. Hietaharju, R. Croft, R. Alam, P. Birch, A. Mong, and M. Haanp？？, “Chronic neuropathic pain in treated leprosy,” The Lancet, vol. 356, no. 9235, pp. 1080–1081, 2000.
[24]
C. Lund, M. Koskinen, S. Suneetha et al., “Histopathological and clinical findings in leprosy patients with chronic neuropathic pain: a study from Hyderabad, India,” Leprosy Review, vol. 78, no. 4, pp. 369–380, 2007.
[25]
A. J. Hietaharju, E. Lasry-Levy, V. V. Pai, et al., “PO30-FR-06 prevalence of neuropathic pain in patients with treated leprosy,” Journal of the Neurological Sciences, vol. 285, p. S318, 2009.
[26]
F. H. Pucci, C. R. Teófilo, S. G. A. Arag？o, and L. G. F. Távora, “Pain in hansen’s disease patients,” Revista DOR, vol. 12, no. 1, pp. 15–18, 2011.
[27]
O. M. Haroun, A. Hietaharju, E. Bizuneh, et al., “Investigation of neuropathic pain in treated leprosy patients in Ethiopia: a cross-sectional study,” Pain, vol. 153, no. 8, pp. 1620–1624, 2012.
[28]
S. Chen, J. Qu, and T. Chu, “Prevalence and characteristics of neuropathic pain in the people affected by leprosy in China,” Leprosy Review, vol. 83, no. 2, pp. 195–201, 2012.
[29]
M. J. Mankar, S. M. Joshi, D. H. Velankar, R. K. Mhatre, and A. N. Nalgundwar, “A comparative study of the quality of life, knowledge, attitude and belief about leprosy disease among leprosy patients and community members in shantivan leprosy rehabilitation centre, Nere, Maharashtra, India,” Journal of Global Infectious Diseases, vol. 3, no. 4, pp. 378–382, 2011.
[30]
E. Lasry-Levy, A. Hietaharju, V. Pai, et al., “Neuropathic pain and psychological morbidity in patients with treated leprosy: a cross-sectional prevalence study in Mumbai,” PLOS Neglected Tropical Diseases, vol. 5, no. 3, p. e981, 2011.
[31]
A. G. Mellagi and Y. N. Monteiro, “The religious imaginary of Hansen's disease patients: a comparative study of former inmates of the asylums of S？o Paulo and current Hansen's disease patients,” Historia, Ciencias, Saude-Manguinhos, vol. 16, no. 2, pp. 489–504, 2009.
[32]
G. A. Joseph and P. S. S. Sundar Rao, “Impact of leprosy on the quality of life,” Bulletin of the World Health Organization, vol. 77, no. 6, pp. 515–517, 1999.
[33]
L. S. T. Véras, R. G. de Souza Vale, D. B. de Mello, J. A. F. de Castro, and E. H. M. Dantas, “Pain in leprosy patients undergoing neural mobilisation treatment,” Fisioterapia e Pesquisa, vol. 18, no. 1, pp. 31–36, 2011.
[34]
N. H. J. Van Veen, T. A. R. Schreuders, W. J. Theuvenet, A. Agrawal, and J. H. Richardus, “Decompressive surgery for treating nerve damage in leprosy. A Cochrane review,” Leprosy Review, vol. 80, no. 1, pp. 3–12, 2009.
[35]
N. H. J. van Veen, P. G. Nicholls, W. C. S. Smith, and J. H. Richardus, “Corticosteroids for treating nerve damage in leprosy. A Cochrane review,” Leprosy Review, vol. 79, no. 4, pp. 361–371, 2008.
[36]
R. Melzack, “Pain and the neuromatrix in the brain,” Journal of dental education, vol. 65, no. 12, pp. 1378–1382, 2001.
[37]
R. Melzack, “From the gate to the neuromatrix,” Pain, supplement 6, pp. S121–S126, 1999.
[38]
D. N. Lockwood, “Editor's choice June 2012: scales for measuring everything,” Leprosy Review, vol. 83, no. 2, pp. 119–120, 2012.
