Giesel et al reported a clinical prediction rule for distinguishing neuritis from neuropathic pain in a patient with leprosy. The authors are from Oswaldo Cruz Institute, Federal University of the State of Rio de Janeiro, Evandro Chagas National Institute of Infectious Diseases, Estacio de Sa University and Pedtro Ernesto University in Brazil.
Patient selection: leprosy
Neuropathy in leprosy is associated with entry of the mycobacteria around small nerve fibers.
Neuritis shows neural pain in conjunction with motor impairment and/or sensory signs in the corresponding nerve. Electrophysiological studies show demyelinating signs. Corticosteroid therapy results in pain relief or clinical improvement.
Clinical prediction rule for neuritis - all of the following:
(1) pain onset < 90 days OR pain with neurological symptoms <= 30 days
(2) pain worse on movement
(3) triggering of pain by palpation
The rule has false positives (resulting in steroid therapy) but is efficient in excluding patients without neuritis, thereby reducing unnecessary steroid therapy overall. A common problem in the treatment of patients is overuse of steroids and delay in initiation of more appropriate therapy.
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