Pain management in hemophilia: expert recommendations

Abstract

Summary Introduction As a typical consequence of bleeding into muscles and joints, patients with severe hemophilia suffer from acute and chronic pain. In spite of its high prevalence, pain in this patient group is not always sufficiently considered or treated in an effective manner. Aim The recommendations presented in this paper address possible improvements in pain management in hemophilia patients and particularities that have to be taken into account in this patient group. Method The manifold aspects of pain management in hemophilia patients were discussed within the framework of an expert meeting. Based on the available literature and the experts’ clinical experience, the participants developed a set of recommendations presented in this paper. Results Pain management in patients with hemophilia is often insufficient, a fact that not only influences the patients’ quality of life but also implies the risk of difficult to manage chronic pain. Both the prevalent polypharmacy (due to comorbidities) as well as the underlying disease itself present special challenges to pain therapy in this patient group. The present review and recommendations are intended to support medical professionals in recognising the risks of pain chronicity, applying basic principles of multimodal pain therapy, including the options of psychological intervention and modalities of physical medicine in therapy concepts, and reaching a comprehensive understanding of the range of analgesic options available.

Physical therapy within US HTCs: A multicentre survey of utilization, practice patterns and pain management approaches

“…10 PTs provide a variety of interventions, including strengthening, range of motion, proprioception and coordination training, functional training and orthotics/shoe adaptations; all of which assist with pain management. [11][12][13] As a component of multimodal pain management, physical medicine and rehabilitation plays an important role in prevention and treatment of chronic haemophilic arthropathy and associated pain. In collaboration with other disciplines, physical medicine thus contributes to improving or maintaining functionality of PWBD.…”

“…Progressive strength training demonstrated improved muscle strength, functional capacity and reduction in pain with an improvement in self‐rated health status 10 . PTs provide a variety of interventions, including strengthening, range of motion, proprioception and coordination training, functional training and orthotics/shoe adaptations; all of which assist with pain management 11–13 . As a component of multimodal pain management, physical medicine and rehabilitation plays an important role in prevention and treatment of chronic haemophilic arthropathy and associated pain.…”

Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

“…If central sensitization is suspected, antidepressants and anticonvulsants should be considered as comedications. Caution must be used when prescribing selective serotonin reuptake inhibitors (SSRI) because of their activity on platelet serotonin reuptake and related inhibition of platelet aggregation with an increased risk of bleeding [ 91 ]. The endocannabinoid system is a promising target for osteoarthritis pain [ 92 ].…”

“…Chronic pain management also envisages enhanced self-management, and behavioral and motivational changes. Among these techniques, mindfulness exercises, cognitive behavioral approaches, and biofeedback have been proposed in hemophilia [ 91 ]. Cognitive behavioral therapy has been studied in a prospective two-arm single-blind parallel-group controlled trial showing to be effective in improving chronic pain, quality of life, and emotional status of patients with hemophilia [ 94 ].…”

Pain in Hemophilia: Unexplored Role of Oxidative Stress

“…Pain affects physical and mental health and impairs HRQoL [ 12 , 13 , 14 , 15 ]. The lack of evidence-based guidelines for hemophilia-specific pain is recognized globally [ 12 , 16 , 17 , 18 ]. Pain is one of the compelling concerns associated with joint damage from the patient’s perspective.…”