The description of HIV- associated sensory neuropathy symptoms in individuals of African ancestry whose home-language is isiZulu

Abstract

In South Africa, English-language versions of neuropathic pain screening tools typically are used to screen for and diagnose neuropathic pain in the clinical and research setting. It is assumed that most individuals understand the Englishlanguage symptom descriptors in these tools (e.g. burning, pins-and-needles, aching, tingling or itching) despite English being the first-language of less than 10% of South Africans. The objectives of this study was firstly to determine what isiZulu terms are used to describe the symptoms of neuropathic pain by individuals whose home-language is isiZulu, and secondly, to determine the level of understanding of typical English neuropathic pain descriptors by these isiZulu speakers. Fifty-four participants with symptomatic HIV-associated sensory neuropathy (HIV-SN) were recruited to participate in the study. Participants were firstly asked to describe, in isiZulu, the pain and/or abnormal sensations in their feet and lower legs. Thereafter, a list of common English neuropathic pain descriptors was read to participants and they were asked to identify which words and phrases described their sensory symptoms. If they identified a particular term as describing their symptoms, participants were asked to provide an isiZulu equivalent for that English term. Participants typically used the isiZulu words “ziyashisa” (hot-48%), “amajaqamba/amacramps” (cramping-35%), “ziyaluma/kuyaluma” (itching-22%), “ndikindiki” (numb-22%) or phrases indicating numbness in their feet and lower legs to spontaneously describe their symptoms. When prompted with English neuropathic pain descriptors, “cramping” (89%) was the most selected term followed by the terms “hot” (87%), “burning” (65%), “tight” (61%) and “itching” (59%). The English terms that were the least understood by participants included “throbbing” (96% of participants did not understand the term), “radiating” (83% did not understand the term), “tingling” (78% did not understand the term), “pricking” (72% did not understand the term), “aching” (70% did not understand the term) and “numb” (63% did not understand the term). Overall, when isiZulu speakers with HIV-SN describe their neuropathic symptoms spontaneously, the descriptors used are similar to commonly-used English neuropathic pain descriptors (when prompted with the terms). However, the understanding of English terms can be poor, indicating the need for the development of neuropathic screening and assessment tools in languages more accessible for the patients who are being assessed. The results obtained contribute to a better understanding of the description of neuropathic pain in isiZulu speakers, which will aid in the diagnosis and management of neuropathy in individuals prone to neuropathy.