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Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Objectives: To identify patients with typical symptoms of neuropathic pain in a well-defined cohort of multibacillary patients being followed up as part of a relapse study in Ethiopia; to identify risk factors for the development of neuropathic pain., Design: 96 patients who had completed MDT more than 10 years previously participated in the study, through a questionnaire., Results: 28 (29%) had symptoms of neuropathic pain and it was reported as severe in 12. Because the past history of these subjects is well documented, a risk factor analysis was carried out. The presence of leprosy-related impairment was the only significant risk factor for neuropathic pain that was identified., Conclusions: Neuropathic pain is an important problem in a proportion of people previously treated for leprosy. Further research into the management of the condition is required.

Leprosy type 1 reactions (T1R) are immune-mediated events with inflammation of peripheral nerves and skin. We report the clinical outcomes of a closely monitored open prospective trial in which eight Nepali and 33 Ethiopian patients with T1Rs were treated with an Indian generic formulation of ciclosporin (Cn; 5-7.5 mg/kg/day) for 12 weeks and followed up for 24 weeks after starting treatment. Outcomes were measured using a clinical severity score. Among the Nepalis, 75-100% improved in all acute clinical parameters; 67-100% patients maintained improvement, except for those with acute sensory nerve impairment among whom 67% relapsed after stopping treatment. The skin lesions of all Ethiopians on 5 mg/kg/day of Cn improved and 50-60% had peripheral nerve function improvement. Most Ethiopians needed a higher dose of Cn to improve nerve impairment and neuritis, and 50-78% of them developed worse clinical severity scores when Cn was stopped. Four Ethiopians and two Nepalis developed elevated serum creatinine levels on 7.5 mg/kg/day Cn, and three (9%) Ethiopians developed treatable hypertension. This suggests that Cn monotherapy is an effective treatment for severe T1R with few adverse effects. A dose of 5 mg/kg/day seems efficacious in Nepalis, but a higher dose may be required in Ethiopian patients.

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.

Evidence is accumulating that nitric oxide (NO) produced by macrophages has a role in the pathogenesis of reactions in leprosy. We followed the urinary levels of the metabolites of NO [nitrite (NO2-) and nitrate (NO3-)] and the clinical response to prednisolone treatment in leprosy patients (n = 9) admitted to ALERT leprosy hospital Addis Ababa, Ethiopia, because of reversal reaction (RR) or erythema nodosum leprosum (ENL). In untreated reactional leprosy patients, the levels of urinary NO metabolites (1645 +/- 454 microM, n = 9, ENL = 4, RR = 5) decreased significantly 2 weeks after high dose prednisolone treatment (1075 +/- 414 microM, P < 0.05), and remained stable 4 (895 +/- 385 microM, P < 0.02) and 6 weeks following treatment initiation (1048 +/- 452 microM, P < 0.02). This decrease was also present when the reactional patients were subdivided according to the type of reaction (ENL, RR) and coincided with a clinical improvement. In patients showing a poor clinical response to steroids, no or minor effects on the urinary NO metabolite levels were observed. We conclude that there is a correlation between the decrease in urinary NO metabolites and a favourable clinical response after high dose prednisolone treatment of reactional leprosy patients.