Management of neuropathic pain in Senegal: Expertise of National Center of Orthopedic Equipment, Dakar.
Dr Ngor Side DIAGNEa, Dr Amadou Koura NDAOa, Dr Maouly FALLb, Prof Lalla Bouna SECKb, Prof Fatima LMIDMANIb, Prof Abdellatif EL FATIMIb
a CHU Fann, Centre National d'Appareillage Orthopedique, b CHU Fann, service de neurologie
Introduction: Neuropathic pain is serious and its treatment difficult. Treatment is efficient, when quality of life is increased .
Objective: To determine the frequency of neuropathic pain at the National Centre of Orthopaedic Equipment, Dakar, Senegal and to study the difficulties of management of neuropathic pain according to international guidelines.
Methodology: A prospective study was undergone in the National Centre of Orthopaedic Equipment in Dakar, Senegal. Study took place from October 2014 to January 2015. Patients with pain over one month answered the neuropathic pain questionnaire and those with over 4 points were enrolled. Pain intensity was evaluated with Visual Analogic Scale, motor function with Medical Research Council Test. Major function (prehension, work, daily activity, professional activity and sleep) were appreciated. We verified the conformity of complementary exams. Evaluation was done before treatment, three weeks and two months after. Treatment was based on international guidelines.
Results: 43 patients suffered neuropathic pain. The sex ratio was 0.96. The mean age was 52.22. The mean score of Visual Analogic Scale was 5.75. Working was difficult (33.96%), impossible (4 cases), and up and down stair climbing impossible ( 18.83%). 18.86% patients could not walk more than 1000 meters and 13. 20 % of patients could not pick something up. Professional activity was stopped in 2 cases. Sleep disorders were noted in 33.96%. Complementary exams were done in 54.71% and 9.43% were not compliant with international guidelines. Most of the patients received Amitryptiline (54. 71%) and adverse effects were noted only in 3 cases. With a two months follow-up, dimensions of quality of life were improved in 94.53% of cases.
Discussion and Conclusion: Treatment of neuropathic pain improved quality of life. In African country, the choice of molecule must take into account its efficacy and its accessibility. Rehabilitation is important in management of neuropathic pain. It increases function and improves quality of life. The unnecessary complementary exams increase the cost, and general practitioners need a specific piece of information about the neuropathic pain and its treatment.
Blond S, N. Buisset, G. Touzet, N. Reyns, R. Martins. Techniques de neurostimulation et douleurs réfractaires. Annales de réadaptation et de médecine physique 2008 ;51 :432-440.
Keywords : neuropathic pain