(LML) Treatment for neuropathic pain

Leprosy Mailing List – April 27,  2019

Ref.:   (LML)  Treatment for neuropathic pain

From:  Ben Naafs, Munnekeburen, the Netherlands

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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

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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