Leprosy Mailing List – April 28, 2019
Ref.: (LML) Treatment for neuropathic pain
From: Nanna Brix Finnerup, Denmark
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 28, 2019
Ref.: (LML) Treatment for neuropathic pain
From: Wim Theuvenet, Apeldoorn, the Netherlands
Dear Pieter,
Francine Brandão raises an important topic: the treatment of neuropathy in leprosy (LML, April 23, 2019).
When the neuropathic pain is caused by a local swelling and entrapment of one of the larger peripheral nerves, one can consider doing a simple nerve decompression at the side of nerve entrapment. There is as far as I can see no discussion that this is a simple and effective method to reduce this type of pain when enlarged and tender nerves are found!
Wishing you all the best,
Willem Theuvenet
Willem J.Theuvenet, M.D., Ph.D,
Plastic, Reconstructive and European Board Certified Hand Surgeon,
The Netherlands
Consultant/ trainer for the NLR and the TLMI
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 27, 2019
Ref.: (LML) Treatment for neuropathic pain
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
Francine Brandão raises an important topic: the treatment of neuropathy in leprosy (LML, April, 2019). She is right, patients with leprosy neuropathic pain are often given steroids. After RFT, the more accepted approach is treatment with tricyclic antidepressants, duloxetine, venlafaxine, gabapentin and pregabalin. With not always good results. Nerve relief surgery will often be of help.
I myself have used with some success capsaicin for post herpetic pains.
The mechanism of the several neuropathic pains is outside my knowledge. But in the skin, I understood the importance of the peripheral nociceptive nerve fibres and capsaicin's influence on it. In leprosy these fibres are gone in the patches and most like in the skin supplied by an affected nerve fibre. Therefore, I have never tried it.
In leprosy the neuropathic pain is mostly experienced in the affected peripheral nerve trunk. Neuropathic pain in other conditions (herpes zoster, diabetes) may have different origins.
We have contacted ILSL in Bauru where there is more knowledge about neuropathic pain and both Dr Garbino and Prof Jaison told us they had no experience with capsaicin in leprosy.
In the past there was a time we thought there were nociceptive fibres in the epineurium who survived the reactions. Thus, it may be worthwhile to try capsaicin above an affected nerve trunk.
We hope that someone with experience cam answer your question better then we.
We also hope that researchers with more knowledge will enlighten us.
Regards,
Ben
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 25, 2019
Ref.: (LML) Classification of patients and interruption of transmission
From: Rajeev B Dudhalkar, Maharashtra, India
Dear Pieter,
Classification of patients and interruption of transmission by Joel Almeida, April 14, 2019. I think we are not addressing very basic issues of new case detection and strategy to detect infectious leprosy cases.
This is very much evident from the prevailing flowcharts for leprosy diagnosis as well as grouping for MDT. Does not give the scope for the application of the most crucial cardinal/ diagnostic sign 'Presence of AFB in skin smear examination', for the detection of infectious cases.
Now we don't see the plateau in a graph of new case detection trend in terms of absolute number for almost past 10 years. When source of infection remains unchecked due to undetected infectious cases left in the community. which are difficult to diagnose at the peripheral health unit. The problem is non availability of skin smears examination facility in an integrated public health system for the diagnosis of infectious cases,
I am once again sharing a flow chart for the application of three diagnostic signs, so that under or over diagnosis can be avoided while examining leprosy suspects in the field condition.
This is my determination for leprosy free world compelling me to respond.
With best regards,
Rajeev B. Dudhalkar
Mob. No. 9324381408
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 25, 2019
Ref.: (LML) Sasakawa Health Foundation
From: SHF, Tokyo, Japan
Dear Mr. Pieter AM Schreuder,
Warm Greetings from Sasakawa Health Foundation again. I'm afraid, I sent you the wrong e-mail address. Could you change it?
As you may have already known, the name of the foundation has been changed to "Sasakawa Health Foundation" from today and email address for our grant program as well as the website have also been changed as below.
Email Address: hansen@shf.or.jp
Website: https://www.shf.or.jp
Although the old email address (smhf@tnfb.jp) will be effective by the end of May, we ask you to please update your contact list with our new address.
Thank you for your kind attention.
With best regards,
Sasakawa Memorial Health Foundation
*****************************************************
Sasakawa Health Foundation
email: hansen@shf.or.jp (Hansen's disease program)
grant@shf.or.jp (Grant program on Hansen's disease)
visit our website at https://www.shf.or.jp
Tel：81-3-6229-5377
Fax：81-3-6229-5388
******************************************************
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 24, 2019
Ref.: (LML) Treatment for neuropathic pain
From: Pieter Schreuder, Maastricht, the Netherlands
Dear colleagues,
Ben Naafs sent us the following references regarding the LML letter by Francine Brandão of April 23, 2019. He is not sure if topical capsaicin has ever been tried in leprosy. We ask those who have tried this application in leprosy to send us their experiences.
References topical application of capsaicin:
P. Anand. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. British Journal of Anaesthesia Volume 107, Issue 4 October 2011
Summary: Topical capsaicin formulations are widely used to manage pain. Low-concentration creams, lotions, and patches intended for daily skin application have been available in most countries since the early 1980s. Prescriptions are usually not needed for these self-administered medicines, which often have not been reviewed formally by drug regulatory authorities. The recent approval in the EU and USA of a prescription-strength high-concentration single-administration capsaicin 8% patch (Qutenza™) with a duration of action over many weeks invites an examination of recent advances in the understanding of capsaicin's mechanism and site of action.
Editor's key points
In this review, which does not cover other naturally occurring or synthetic TRPV1 agonists, we discuss the potential utility of topically administered capsaicin for the management of pain in classical peripheral neuropathies and other hypersensitivity disorders, some of which are currently considered as idiopathic. Furthermore, we seek to elucidate the molecular and cellular basis of capsaicin treatment, and clarify misunderstandings, particularly with respect to the involvement of substance P depletion.
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Ganesan Baranidharan, Sangeeta Das, and Arun Bhaskar. A review of the high-concentration capsaicin patch and experience in its use in the management of neuropathic pain. Ther Adv Neurol Disord. 2013 Sep; 6(5): 287–297. doi: 10.1177/1756285613496862 PMCID: PMC3755533 PMID: 23997814
Abstract: In the European Union, the high-concentration capsaicin patch is licensed for the management of neuropathic pain conditions in nondiabetic patients, including postherpetic neuralgia (PHN) and HIV-associated distal sensory polyneuropathy (HIV-DSP). However, in the USA, the Food and Drug Administration approved its use only in PHN (post herpetic neuralgia) patients. Capsaicin is a transient receptor potential vanilloid-1 agonist, which increases the intracellular calcium ion concentration. This triggers calcium-dependent protease enzymes causing cytoskeletal breakdown and leads to the loss of cellular integrity and 'defunctionalization' of nociceptor fibres. Efficacy and therapeutic effect have been shown in several clinical studies of PHN and HIV-DSP. The high-concentration capsaicin patch and its practical application are different from low-concentration creams; one application can help for up to 3 months.
Neuropathic pain is a major problem among leprosy patients. In an editorial by Maija Haanpää, Diana N.J. Lockwood and Aki Hietaharju (Leprosy Review (2004) 75, 7-18) the concept, clinical features and diagnosis of neuropathic pain are reviewed. The possible pathophysiological mechanisms, treatment challenges and research needs in this area are discussed. The only topical application mentioned in this review is lidocaine, but not discussed in detail.
It should be stressed that chronic treatment with steroids, which we see often in practice, is clearly not the solution and should be discouraged.
Yours sincerely,
Pieter AM Schreuder
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
Leprosy Mailing List – April 23, 2019
Ref.: (LML) Sasakawa Health Foundation
From: SHF, Tokyo, Japan
Dear Sir/ Madam,
Warm greetings from Sasakawa Memorial Health Foundation.
As you may have already known, the name of the foundation has been changed to "Sasakawa Health Foundation" from today and email address for our grant program as well as the website have also been changed as below.
Email Address: grant@shf.or.jp
Website: https://www.shf.or.jp
Although the old email address (smhf@tnfb.jp) will be effective by the end of May, we ask you to please update your contact list with our new address.
Thank you for your kind attention.
With best regards,
Sasakawa Memorial Health Foundation
*****************************************************
Sasakawa Health Foundation
email: hansen@shf.or.jp (Hansen's disease program)
grant@shf.or.jp (Grant program on Hansen's disease)
visit our website at https://www.shf.or.jp
Tel：81-3-6229-5377
Fax：81-3-6229-5388
******
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder