Characteristics of neuropathic pain after multidrug therapy in a tertiary referral centre for leprosy: A cross-sectional study in Rio de Janeiro, Brazil

Objectives: To describe the characteristics of neuropathic pain in treated leprosy patients. Methods: A cross-sectional study was conducted amongst patients with leprosy reporting persistent pain after multidrug therapy (MDT), during the period of 2011-2012. Patients with hand and foot injuries, presenting leprosy reactions, deformities or other painful syndromes described in medical records were excluded. The frequency of neuropathic pain was assessed using the Douleur Neuropathic 4 (DN4) and clinical examination. The McGill Pain Questionnaire, the Visual Analogue Scale (VAS) and patients' self-report were used to describe the characteristics of pain. Results: All the 50 patients evaluated showed characteristics of neuropathic pain according to the clinical assessment and 48 according to the DN4. Sixty-eight per cent of the patients with pain in the upper limbs complained about the ulnar nerve sensory location, whereas for the lower limbs, 66% complained about the tibial nerve. All of the patients reported feeling pain for more than one year, and the mean intensity presented by the group in the VAS was 4.9 cm. Among the participants, 76% had moderate to severe pain. All individuals in our sample were taking prednisone at the moment of the interview, despite the absence of leprosy reaction. Conclusions: Definite neuropathic pain was found in 40% of the sample and probable chronic neuropathic pain was found in the remaining 60%. Some clinical leprosy characteristics can contribute to neuropathic pain, such as lepromatous form, more than one year since diagnosis and sensorimotor impairments. Prednisolone is grossly over-prescribed.