Is Neuropathic pain in treated leprosy due to thalidomide?
Neuropathic pain in treated leprosy patients

Lasry-Levy et al (1) in their study do not provide an explanation for the cause of the neuropathic pain in treated leprosy patients, except to state that it is of recent origin. Contrary to previous reports (2), they emphasise that the pain is associated with nerve enlargement and tenderness and suggest that on going inflammation may be important in causation. The distribution of pain in a ‘glove and stocking’ distribution in this paper and previous publications (2-4) indicate that a dying back neuropathy could be the cause. Three of their patients had received thalidomide and at least in this group, the ingestion of this drug is the probable cause of neuropathic pain. A nerve biopsy would confirm that the large myelinated fibres are reduced in number, which is typical of thalidomide neuropathy (5). It would be justifiable to withdraw thalidomide, until the results of the nerve biopsies have been published.
References
1. Lasry-Levy E, Hietaharju A, Pai V, Ganapati R, Rice ASC, et al. Neuropathic pain and psychological morbidity in patients with treated leprosy: A cross-sectional prevalence study in Mumbai. PLoS Negl Trop Dis. 2011 March; 5(3): e981
2.Hietaharju A, Croft R, Alam R, Birch P, Mong A, et al. Chronic neuropathic pain in treated leprosy. Lancet 2000; 356: 1080-1081.
3. Stump PR, Baccarelli R, Marciano LH, Lauris JR, Teixeira MJ, et al. neuropathic pain in leprosy patients. Int J Lepr other Mycobact Dis. 2004; 72: 134-138.
4.Lund C, Koskinen M, Suneetha S, Lockwood DN, Haanpaa et al. Histopathological and clinical findings in leprosy patients with chronic neuropathic pain: a study from Hyderabad, India. Lepr Rev.2007; 78: 369- 380.
5, Fullerton PM, O’Sullivan DJ. Thalidomide neuropathy: a clinical electrophysiological and histological follow-up study. J Neurol Neurosurg Psy. 1968; 31: 543-551.