Body Pain

Original Editor - Liana Vorslava Top Contributors - Liana Vorslava
Top Contributors - Liana Vorslava  

Introduction

The current best-evidence in physiotherapy is for reducing pain and improving functionality, gray matter morphologic features, and pain cognition's in individuals with chronic spinal pain.[1]

Leprosy is one of the chronic infectious disease caused by Mycobacterium leprae,  The disease can induce neuropathy in peripheral nerve trunks, associated with sensory loss in skin lesions. Leprosy neuropathy occurs before, during, or after multidrug therapys and affects around 65% of patients.[2]

Case definitions

Leprosy

Patients had leprosy when they had one of the following signs: hypopigmented or reddish skin lesion with loss of sensation; thickened peripheral nerve to palpation, or presence of acid-fast bacilli in a slit-skin smear.This case definition includes patients who had yet to complete a full course of multidrug treatment, as well as patients who relapsed after completing a full course of treatment. It also includes mycobacteriologically cured subjects with late reactions.

Subclinical neuropathy

Patients with leprosy as defined above and with no clinical evidence of mechanosensory and/or motor impairment in an area of the hand innervated by 1 or more nerve, but abnormal nerve conduction studies, were categorised as “subclinical neuropathy.” Electrophysiology data for such patients were usually available because they had previously participated in the “Treatment of Early Neuropathy in LEProsy”

Neuropathy

Patients with leprosy as defined above and clinical evidence of sensory or motor deficits were allocated to the “neuropathy” category: Mechanosensation was assessed using Semmes–Weinstein monofilaments (details below) and motor function using the modified Medical Research Council (MRC)  Sensory impairment was defined as not being able to perceive the 0.2-g monofilament at 2 points of 3 tested in each innervation territory of the hand.

Painful neuropathy, pain distribution, and interference

Patients with leprosy and neuropathy as defined above and pain in the innervation territory of the neuropathic site were allocated to the “painful neuropathy” group. These patients were asked to mark the area of their pain on a body image template. The pain drawing of each patient was digitized and transformed into a colour-coded heat map of frequent pain areas, in which white areas mark body parts in which no patient felt spontaneous pain, while dark red areas indicate that most patients felt pain. The light-yellow areas represent body parts in which few patients experienced pain; orange and light-red areas represent a medium frequency of pain occurrence. Patients also filled in the short form of the Brief Pain Inventory.

Pain and pain interference

Body chart showing superimposed pain areas reported by all patients with pain. The white areas mark body parts in which no patient felt spontaneous pain. In the dark red areas, most patients felt pain. The light-yellow areas represent body parts in which few patients experienced pain, and orange and light-red areas represent a medium frequency of pain occurrence. Most pain appeared in the ulnar territory, and a second hotspot was the knees of the patients.[3]

Physiotherapy in a treatment programme: it is becoming increasingly evident that simple physiotherapy methods for the prevention of deformity

can be widely and effectively used in a domiciliary treatment programme.

Body Pain

References

  1. Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, Cagnie B, Danneels L, Nijs J. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: a randomized clinical trial. JAMA neurology. 2018 Jul 1;75(7):808-17.
  2. Haroun OM, Vollert J, Lockwood DN, Bennett DL, Pai VV, Shetty V, Wakade AV, Khodke AS, Schilder A, Pfau D, Enax-Krumova EK. Clinical characteristics of neuropathic pain in leprosy and associated somatosensory profiles: a deep phenotyping study in India. Pain Reports. 2019 Nov 1;4(6):e743.
  3. Haroun OM, Vollert J, Lockwood DN, Bennett DL, Pai VV, Shetty V, Wakade AV, Khodke AS, Schilder A, Pfau D, Enax-Krumova EK. Clinical characteristics of neuropathic pain in leprosy and associated somatosensory profiles: a deep phenotyping study in India. Pain Reports. 2019 Nov 1;4(6):e743.