Vitamin D Deficiency as a Factor Associated with Neuropathic Pain in Multibacillary Type Morbus Hansen
DOI:
https://doi.org/10.33192/smj.v76i8.268656Keywords:
Morbus Hansen, Multibacillary, Neuropathic Pain, Serum Vitamin D, Vitamin D DeficiencyAbstract
Objective: Morbus Hansen (MH), caused by Mycobacterium leprae, is marked by neuropathic pain. Prior studies link low vitamin D levels to diabetic neuropathic pain, yet research on its role in MH-related neuropathic pain is limited. This study investigates the role of vitamin D deficiency in MH-related neuropathic pain.
Materials and Methods: An analytical cross-sectional study was conducted among multibacillary (MB) MH patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali from April to August 2023. Neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire, while serum 25(OH)D levels determined vitamin D status. The cutoff for deficiency was determined via ROC curve analysis.
Results: Among 42 participants, those without neuropathic pain exhibited higher mean serum vitamin D levels than those with neuropathic pain (28.69 ± 8.16 vs. 22.11 ± 9.54 ng/ml; p=0.021). The ROC curve identified a cutoff value of 30.25 ng/ml, categorizing participants into vitamin D deficiency (<30.25 ng/ml) and non-deficiency (≥30.25 ng/ml) groups. Bivariate analysis revealed a heightened incidence of neuropathic pain among MH patients with serum vitamin D levels below the designated cutoff point (OR: 6.60; 95%CI: 1.484-29.355; p=0.022). Multivariate analysis indicated that two variables significantly correlated with neuropathic pain in MH patients: vitamin D deficiency (OR: 14.337; 95%CI: 2.431-84.542; p=0.003) and peripheral nerve enlargement (OR: 12.564; 95%CI: 2.096-75.307; p=0.006).
Conclusion: Disparities in average vitamin D levels were observed between MH patients with and without neuropathic pain. Vitamin D deficiency, alongside peripheral nerve enlargement, emerged as significant risk factors for neuropathic pain in MH patients.
References
Assy MH, Draz NA, Fathy SE, Hamed MG. Impact of vitamin D level in diabetic people with peripheral neuropathy. Egyptian Journal of Neurology, Psychiatry and Neurosurgery [Internet]. 2021;57(1). Available from: https://doi.org/10.1186/s41983-021-00370-9
Qu GB, Wang LL, Tang X, Wu W, Sun YH. The association between vitamin D level and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: An update systematic review and meta-analysis. J Clin Transl Endocrinol [Internet]. 2017;9:25–31. Available from: http://dx.doi.org/10.1016/j.jcte.2017.04.001
Theresia L. Toruan, Mutia Devi, Theodorus, Rivai AM. Relationship between 25-Hydroxy Vitamin D Levels and Type of Morbus Hansen. Bioscientia Medicina : Journal of Biomedicine and Translational Research. 2021 Sep 20;5(9):883-9.
Rusyati LM, Adiguna MS, Wiraguna AAGP, Puspawati NMD, Sudarsa P. Correlation of serum Vitamin D receptor level with bacterial index in multibacillary leprosy patients at Sanglah General Hospital, Bali-Indonesia. Biomedical and Pharmacology Journal. 2019;12(1):469-72.
Sari A, Altun ZA, Karaman CA, Kaya BB, Durmus B. Does vitamin D affect diabetic neuropathic pain and balance? J Pain Res. 2020;13:171-9.
Putz Z, Martos T, Németh N, Körei AE, Vági OE, Kempler MS, et al. Is There an Association Between Diabetic Neuropathy and Low Vitamin D Levels? Curr Diab Rep. 2014;14(10):1-6.
Fithrie A, Fitri FI, Putra MR. Association of Vitamin D Level and Nerve Conduction Study Parameters with Cognitive Function in Diabetic Neuropathy Patients. Open Access Maced J Med Sci. 2021;9(B):72-8.
Taslim Pinzon R, Angela A. Closing the Gap for Pharmacological Treatment of Painful Diabetic Neuropathy : the Potential Role of Vitamin D. MNJ (Malang Neurology Journal). 2022;8(1):49-52.
Luong KVQ, Nguyen LTH. Role of the vitamin D in leprosy. Am J Med Sci. 2012;343(6):471-82.
Shipton EA, Shipton EE. Vitamin D and pain: Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. Pain Res Treat. 2015;2015:904967.
Pinzon RT, Wijaya VO, Veronica V. The Benefits of Add-on Therapy of Vitamin D 5000 IU to the Vitamin D Levels and Symptoms in Diabetic Neuropathy Patients : A Randomized Clinical Trial. J Pain Res. 2021;14:3865-75.
Mahmoud HMM, El-Azab MH, Butros MKF, Mourad AA. The Relationship between Vitamin D level and incidence of Diabetic Peripheral Neuropathy in Diabetic patients type 2. Benha Medical Journal. 2021;38(3):908-24.
Pinzon RT, Tjung A, Pradana AW. Is there any relationship between vitamin d levels and the severity of diabetic peripheral neuropathy? Romanian Journal of Neurology/ Revista Romana de Neurologie. 2020;19(2):89-95.
Shaheen Anodiyil Mohamed, Thekke Veettil S, Ali Kalathingal M. Vitamin D and Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus: A Current Perspective. Scholars Journal of Applied Medical Sciences. 2021;9(1):142-8.
Shehab D, Al-Jarallah K, Abdella N, Mojiminiyi OA, Al Mohamedy H. Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus. Med Princ Pract. 2015;24(3):250-6.
Alam U, Nelson AJ, Cuthbertson DJ, Malik RA. An update on Vitamin D and B deficiency in the pathogenesis and treatment of diabetic neuropathy: A narrative review. Future Neurol. 2018;13(3):135-42.
Zambelis T, Papadakis G, Kokotis P, Villiotou V, Dogkas N, Karandreas N. Lack of definite association of Vitamin D deficiency with diabetic neuropathy. investigation in Greek and in bangladeshi patients. In Vivo. 2017;31(2):259-61.
Habib AM, Nagi K, Thillaiappan NB, Sukumaran VK, Akhtar S. Vitamin D and Its Potential Interplay With Pain Signaling Pathways. Front Immunol. 2020;11:1-19.
Dalia IWA, Abdelmula MA, Zeinab AE, AbdElkarim AA. Association of vitamin D with diabetic neuropathy among Sudanese patients with type 2 diabetes mellitus. Nigerian Journal of Basic and Clinical Sciences. 2019;16(2):79-82.
Ou Y, Liang Z, Yang Y, Zhou YK. Association of diabetic peripheral neuropathy with vitamin D levels depends on vitamin D status. Med Sci Monit. 2021;27:e931244.
Oraby MI, Srie MA, Abdelshafy S, Elfar E. Diabetic peripheral neuropathy: The potential role of vitamin d deficiency. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2019;55(1):1-8.
Tiago LM de P, Dos Santos DF, Antunes DE, Tiago LMP, Goulart IMB. Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study. PLoS Negl Trop Dis. 2021;15(9):e0009794.
Giesel LM, Pitta IJR, Da Silveira RC, Andrade LR, Vital RT, Da Costa Nery JA, et al. Clinical and neurophysiological features of leprosy patients with neuropathic pain. Am J Trop Med Hyg. 2018;98(6):1609-13.
Toh HS, Maharjan J, Thapa R, Neupane KD, Shah M, Baral S, et al. Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy. PLoS Negl Trop Dis. 2018;12(7):e0006610.
Alam U, Petropoulos IN, Ponirakis G, Ferdousi M, Asghar O, Jeziorska M, et al. Vitamin D deficiency is associated with painful diabetic neuropathy. Diabetes Metab Res Rev. 2021;37(1):e3361.
Finnerup NB, Kuner R, Jensen TS. Neuropathic pain 1 Neuropathic Pain: From Mechanisms to Treatment, 2020.
Shipton EA, Shipton EE. Vitamin D and pain: Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. Pain Res Treat. 2015;2015:904967.
Klowak M, Boggild AK. A review of nutrition in neuropathic pain of leprosy. Ther Adv Infect Dis. 2022;9:20499361221102663.
Haanpaa M, Lockwood DNJ, Hietaharju A. Neuropathic pain in leprosy patients. Int J Lepr Other Mycobact Dis. 2004;75(2):134-8.
Faridi M, Widyadharma P, Susilawathi N. Factors that are correlated with the incidence of peripheral neuropathy in patients with Morbus Hansen at Sanglah Hospital Denpasar in 2018. International Journal of Medical Reviews and Case Reports. 2020;(0):1.
Ebenezer GJ, Scollard DM. Treatment and Evaluation Advances in Leprosy Neuropathy. Vol. 18, Neurotherapeutics. Springer Science and Business Media Deutschland GmbH; 2021.p.2337-50.
Raicher I, Stump PRNAG, Harnik SB, De Oliveira RA, Baccarelli R, Marciano LHSC, et al. Neuropathic pain in leprosy: Symptom profile characterization and comparison with neuropathic pain of other etiologies. Pain Rep. 2018;3(2):e638.
Pitta IJR, Hacker MA, Vital RT, Andrade LR, Spitz CN, Sales AM, et al. Leprosy Reactions and Neuropathic Pain in Pure Neural Leprosy in a Reference Center in Rio de Janeiro – Brazil. Front Med (Lausanne). 2022;9:865485.
![](https://he02.tci-thaijo.org/public/journals/156/submission_268656_52915_coverImage_en_US.jpg)
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Siriraj Medical Journal
![Creative Commons License](http://i.creativecommons.org/l/by-nc-nd/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following conditions:
Copyright Transfer
In submitting a manuscript, the authors acknowledge that the work will become the copyrighted property of Siriraj Medical Journal upon publication.
License
Articles are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). This license allows for the sharing of the work for non-commercial purposes with proper attribution to the authors and the journal. However, it does not permit modifications or the creation of derivative works.
Sharing and Access
Authors are encouraged to share their article on their personal or institutional websites and through other non-commercial platforms. Doing so can increase readership and citations.