NEUROPATHIC PAIN CORRELATED WITH QUALITY OF LIFE IMPAIRMENT IN MORBUS HANSEN PATIENTS.
NEUROPATHIC PAIN CORRELATED WITH QUALITY OF LIFE
IMPAIRMENT IN MORBUS HANSEN PATIENTS
Ernesta P Ginting, Thomas Eko Purwata, Purna Putra, Arimbawa, Eka Widyadharma
Neurology Department Udayana University/Sanglah General Hospital Denpasar, Bali, Indonesia
ABSTRACT
Morbus Hansen (MH) is still one of the dreaded disease due to the complications and quality
of life (QoL) impairment that it inflicts. Many factors can lead to the QoL impairment in patients
with MH, including the presence of lesions on the skin that interferes with the appearance, bad
stigma about the disease in community, a long therapy duration, recurrence of leprosy reactions,
the incidence of disability, and the presence of complications of chronic neuropathic pain (NP).
This research aims to find out the proportion and characteristics of NP in MH patients, as well as
to find out the correlation between the NP with the QoL impairment in MH patients.
This research was a cross sectional study. Sampling method was using a non random
consecutive sampling. Data were analyzed with SPSS 20.0 for window. A descriptive analysis
was conducted to determine the proportion of NP incidence and characteristics in MH patients,
lambda test to determine the correlation between the NP with the QoL impairment.
A total sample of 49 people has been obtained since January 6th, 2014 until March 29th,
2014. The proportion of NP in MH patients was 57,1%. The most frequent type of NP was the
sense of tingling (89,3%), with mild intensity (60.7%), the most frequent location was at the
hands and feet (gloves and stockings) (75%), with the average of pain duration was 5.5 months.
The proportion of QoL impairment was 44,9%; with the impairment of Physical Component
Scale (PCS) was 95.5% and the impairment of Mental Component Scale (MCS) was only 27.3%.
This study showed a significantly strong positive correlation between NP and QoL impairment
(p=0,004; r=0,636).
It can be concluded that the presence of NP was more likely in disrupting the QoL in MH
patients.
Keywords : Morbus Hansen, Neuropathic Pain, Quality of Life.
INTRODUCTION
Morbus Hansen (MH) or leprosy, is a
chronic infectious disease caused by
Mycobacterium leprae, a microorganism
that has predilection areas, especially in the
skin and peripheral nerves. It is one of the
most common cause of non-traumatic
peripheral neuropathy.(1)
MH is still a problem faced by most
people of the world, especially in
developing countries. According to the
WHO Weekly Epidemiological Record,
based on the reports from 130 countries,
there are 228,474 new cases of MH during
2010. Indonesia ranks as the third largest
number of MH cases in the world, after
India and Brazil. During 2010, there was
17,012 new cases of MH in Indonesia, with
1,822 cases were already in a state of
second-degree disability.(2)
One of the complications of MH that
get less attention is chronic NP. This may be
due to the severe sensory disturbances that
cause hypesthesia or anesthesia, so pain in
MH is considered to be rare. In fact, the
symptoms of NP can occur in the phase
before treatment, during treatment, and after
completion of therapy.(3)
Presented on Neuropathic Pain Congress - NeuPSIG 2015 | Nice, May 2015
1
Chronic pain that is not treated properly
can cause negative effects on various aspects
of life, including psychological and
functional capacity of daily life.(4) Pain and
the severity degree of pain has a significant
correlation with physical functioning
impairment, emotional functioning, social
role functioning, sleep disturbances, and
decreased quality of life (QoL).(5)
This study aims to determine the
proportion and characteristics of NP in
patients with MH, as well as to determine
the correlation between NP with the QoL
impairment in MH patients.
METHODS
This was a cross-sectional study with
non random consecutive sampling method,
conducted at the Dermatology Clinic of
Sanglah Hospital and Indera Hospital in
Denpasar Bali Indonesia, between January
2014 to March 2014. Subjects are MH
patients who meet the inclusion and
exclusion criteria, and willing to be
respondent by signing the informed consent.
Inclusion criteria of this study are: 1). MH
patients. MH diagnosis was made based on
clinical symptoms and examinations that
was conducted by Dermatology Division
(data taken from a medical record). 2).
Patients who were cooperative and willing
to participate in this study and sign the
informed consent. The exclusion criteria of
this study are: 1). Patients with second
degree disabilities. 2). Patients with NP risk
factors such as diabetes mellitus, use of
alcohol, impaired renal function, malignant
disease, other infectious diseases both
locally and systemically.
MH is diagnosed by finding at least one
of the following cardinal signs (6): 1). Loss
of sensation in a hypopigmented or reddish
skin patch. 2). Peripheral nerve enlargement,
which is accompanied by loss of sensation
and or accompanied by muscle weakness in
the area supplied by the nerve. 3). Presence
of acid-fast bacili in a slit skin smear.
NP was diagnosed with DN4
instrument, which consists of seven items
description of sensory and three items of
sensory dysfunction examination. Scores ≥ 4
is classified as NP, and a score of
IMPAIRMENT IN MORBUS HANSEN PATIENTS
Ernesta P Ginting, Thomas Eko Purwata, Purna Putra, Arimbawa, Eka Widyadharma
Neurology Department Udayana University/Sanglah General Hospital Denpasar, Bali, Indonesia
ABSTRACT
Morbus Hansen (MH) is still one of the dreaded disease due to the complications and quality
of life (QoL) impairment that it inflicts. Many factors can lead to the QoL impairment in patients
with MH, including the presence of lesions on the skin that interferes with the appearance, bad
stigma about the disease in community, a long therapy duration, recurrence of leprosy reactions,
the incidence of disability, and the presence of complications of chronic neuropathic pain (NP).
This research aims to find out the proportion and characteristics of NP in MH patients, as well as
to find out the correlation between the NP with the QoL impairment in MH patients.
This research was a cross sectional study. Sampling method was using a non random
consecutive sampling. Data were analyzed with SPSS 20.0 for window. A descriptive analysis
was conducted to determine the proportion of NP incidence and characteristics in MH patients,
lambda test to determine the correlation between the NP with the QoL impairment.
A total sample of 49 people has been obtained since January 6th, 2014 until March 29th,
2014. The proportion of NP in MH patients was 57,1%. The most frequent type of NP was the
sense of tingling (89,3%), with mild intensity (60.7%), the most frequent location was at the
hands and feet (gloves and stockings) (75%), with the average of pain duration was 5.5 months.
The proportion of QoL impairment was 44,9%; with the impairment of Physical Component
Scale (PCS) was 95.5% and the impairment of Mental Component Scale (MCS) was only 27.3%.
This study showed a significantly strong positive correlation between NP and QoL impairment
(p=0,004; r=0,636).
It can be concluded that the presence of NP was more likely in disrupting the QoL in MH
patients.
Keywords : Morbus Hansen, Neuropathic Pain, Quality of Life.
INTRODUCTION
Morbus Hansen (MH) or leprosy, is a
chronic infectious disease caused by
Mycobacterium leprae, a microorganism
that has predilection areas, especially in the
skin and peripheral nerves. It is one of the
most common cause of non-traumatic
peripheral neuropathy.(1)
MH is still a problem faced by most
people of the world, especially in
developing countries. According to the
WHO Weekly Epidemiological Record,
based on the reports from 130 countries,
there are 228,474 new cases of MH during
2010. Indonesia ranks as the third largest
number of MH cases in the world, after
India and Brazil. During 2010, there was
17,012 new cases of MH in Indonesia, with
1,822 cases were already in a state of
second-degree disability.(2)
One of the complications of MH that
get less attention is chronic NP. This may be
due to the severe sensory disturbances that
cause hypesthesia or anesthesia, so pain in
MH is considered to be rare. In fact, the
symptoms of NP can occur in the phase
before treatment, during treatment, and after
completion of therapy.(3)
Presented on Neuropathic Pain Congress - NeuPSIG 2015 | Nice, May 2015
1
Chronic pain that is not treated properly
can cause negative effects on various aspects
of life, including psychological and
functional capacity of daily life.(4) Pain and
the severity degree of pain has a significant
correlation with physical functioning
impairment, emotional functioning, social
role functioning, sleep disturbances, and
decreased quality of life (QoL).(5)
This study aims to determine the
proportion and characteristics of NP in
patients with MH, as well as to determine
the correlation between NP with the QoL
impairment in MH patients.
METHODS
This was a cross-sectional study with
non random consecutive sampling method,
conducted at the Dermatology Clinic of
Sanglah Hospital and Indera Hospital in
Denpasar Bali Indonesia, between January
2014 to March 2014. Subjects are MH
patients who meet the inclusion and
exclusion criteria, and willing to be
respondent by signing the informed consent.
Inclusion criteria of this study are: 1). MH
patients. MH diagnosis was made based on
clinical symptoms and examinations that
was conducted by Dermatology Division
(data taken from a medical record). 2).
Patients who were cooperative and willing
to participate in this study and sign the
informed consent. The exclusion criteria of
this study are: 1). Patients with second
degree disabilities. 2). Patients with NP risk
factors such as diabetes mellitus, use of
alcohol, impaired renal function, malignant
disease, other infectious diseases both
locally and systemically.
MH is diagnosed by finding at least one
of the following cardinal signs (6): 1). Loss
of sensation in a hypopigmented or reddish
skin patch. 2). Peripheral nerve enlargement,
which is accompanied by loss of sensation
and or accompanied by muscle weakness in
the area supplied by the nerve. 3). Presence
of acid-fast bacili in a slit skin smear.
NP was diagnosed with DN4
instrument, which consists of seven items
description of sensory and three items of
sensory dysfunction examination. Scores ≥ 4
is classified as NP, and a score of