Classificação da dor e avaliação da qualidade de vida em pessoas afetadas pela hanseníase

Abstract

Leprosy is part of the group of neglected diseases and is considered a public health problem in several countries around the world, due to the high number of new cases of the disease, morbidity and socioeconomic impact resulting from complications. Recent studies have shown that people affected by the disease may report experiencing chronic pain during treatment or in the post-discharge period, which affects physical and emotional well-being, relationships, leading to psychological problems and social isolation. There are basically two types of chronic pain that can be present in leprosy patients: a) neuropathic pain and b) nociceptive pain. However, little is known about their prevalence in this population. Furthermore, it is believed that pain may be associated with a worse quality of life in this population. Thus, this study aims to identify the prevalence of chronic pain, its types and to verify the association between pain and quality of life in people affected with leprosy treated in the city of Arapiraca-AL, Brazil. Therefore, an analytical cross-sectional study was carried out on individuals over 15 years of age, of both sexes, treated at the Reference Center for the disease in the city of Arapiraca, Alagoas, Brazil, from August de 2018 to March/2020. Information was obtained from the application of a data collection instrument addressing clinical and demographic data. Medical records and notification forms were consulted to complement this information. Then, the following were evaluated: a) quality of life, using the WHO-QoL-BREF questionnaire; and b) the characterization of pain, through the instruments Douler Neuropathique en 4 questions (DN4) for individuals who report pain. The project was approved by the Ethics Committee for Research with Human Beings at the Federal University of Alagoas (UFAL) (Opinion No. 3,938,849). Individuals were stratified into pain and no pain. A total of 122 affected people were included in the study. There were no differences between the pain and no pain groups regarding the distribution of participants' characteristics. Eighty-four (68.8%) participants reported chronic pain. Participants with pain had lower quality of life scores than those without pain, especially in the physical domains [46.4 (35.7–57.1) vs. 66.1 (50.0-78.6); p <0.001)], psychological [58.3 (45.8–70.8 vs. (68.7–79.2); p = 0.005) and social [66.7 (50.0– 81.2) vs. 75.0 (58.3–83.3); p = 0.041)]. Seventy-two (85.7%) of 84 participants with pain were identified as having neuropathic pain. Participants with neuropathic pain had lower quality of life scores compared to patients with nociceptive pain. It concludes that the prevalence of chronic pain and neuropathic pain was high. People affected by leprosy with pain have lower QoL scores. Thus, it is necessary to implement systematic pain assessment in this population to detect the type of pain for better management and consequent improvement in QoL.