Neuropathic pain in Mali: The current situation, comprehensive hypothesis, which therapeutic strategy for Africa?

Abstract

Introduction

According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as “ pain caused by a lesion or disease of the somatosensory nervous system”. NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients.

Methodology

This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not).

Results

Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females ( p < 10 ⁻⁷) and between two age groups (p 〈10 ⁻³). The 49–58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients.

Discussion/conclusion

This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.

Highlights

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  NeuP pain, irrespective of its type (diabetic NeuP, lumbar radiculopathies, pain linked to HIV, and pain linked to stroke), is encountered frequently in our current neurology practice in Mali.

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  Failed to comply with the NeuP treatment guidelines, thus highlighting the need for better training of health professionals involved in NeuP management in Mali.

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  Amitriptyline is the only validated drug that is readily available and affordable for most patients with NeuP.

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  Other effective drugs to treat NeuP should be on the list of essential drugs. Optimal management of NeuP in Africa also needs to take into account the local socio-cultural context and practices regarding pain.