Assessment and treatment of pain in thalassemia

Abstract

Pain is a subjective symptom whose prevalence can be grossly underestimated. The high proportion of adults with thalassemia who experience chronic pain is evident from recent surveys. However, pain has not received enough attention in the overall management of thalassemia. The association of pain with the type and treatment of thalassemia or with its comorbidities is unclear. Abnormal spine imaging is seen in patients reporting pain, although the role of osteopenia has not been established. Pain becomes more frequent with age. The lower back is the most common site and can be particularly disabling and difficult to treat. Treatable causes, such as extramedullary masses or disc herniation or fractures, must be ruled out. Some adults experience increasing pain when the hemoglobin drops at the end of transfusion cycles. Interdisciplinary management of pain is necessary, while overreliance on medications can be counterproductive. The impact of chronic pain on the quality of life must be acknowledged. Physical therapy, psychological counseling, and vocational rehabilitation are vital to management. I recommend a proactive approach for prevention of pain by maintaining optimal bone density and an active lifestyle. I further propose that a universal tool be adopted to document and characterize pain at routine clinic visits.

The changing epidemiology of the ageing thalassaemia populations: A position statement of the Thalassaemia International Federation

“…Pain is also a common complaint of thalassaemia patients, 46‐48 although not necessarily an effect of reduced bone mineral density and fractures. Thirty‐seven per cent of patients, report having pain during the past 7 days, while 64% report having pain over the past 4 weeks 49 .…”

“…43 Bone disease is also becoming a major concern for thalassaemia patients, with the accompanying pain and fractures seriously affecting the quality of patients.. 44,45 The lifetime fracture rate escalates to 55% for adults with TM and to 71% for adults with TI. Extremity fractures are the most common, and the upper extremity seems to be the most common fracture site.. 45 Pain is also a common complaint of thalassaemia patients, [46][47][48] although not necessarily an effect of reduced bone mineral density and fractures. Thirty-seven per cent of patients, report having pain during the past 7 days, while 64% report having pain over the past 4 weeks.…”

Pain in β-thalassemia major patients: an important yet neglected issue

“…The exact mechanism of pain in thalassemia has not yet been fully elucidated; however, iron overload, low hemoglobin level, and low bone mass have been suggested as potential etiologies [ 4 7 ]. Nevertheless, the current evidence does not confirm these suggestions [ 2 ].…”

“…Nevertheless, the current evidence does not confirm these suggestions [ 2 ]. It is assumed that lower hemoglobin levels, which occur at the end of a transfusion cycle, are possibly associated with worsening of pain in β-TM patients [ 2 7 ]. In addition, due to skeletal changes and bone marrow expansion, the risk of developing pain increases in patients who delay the blood transfusion; however, these relationships still need to be clarified in future studies [ 7 ].…”

Hubungan Kadar Hemoglobin Dan Feritin Dengan Gambaran Konduksi Saraf Pada Anak Talasemia Beta Mayor

“…6 Keluhan gejala klinis yang lebih banyak juga dapat disebabkan kondisi subjek yang terlibat lebih berat berdasarkan kadar hemoglobin dan feritin dibandingkan dengan penelitian sebelumnya. 4,6,15,21 Pada pemeriksaan fisik, jumlah subjek yang mengalami defisit neurologis lebih sedikit dibandingkan yang mengeluhkan gejala klinis. Sebanyak 54% subjek mengeluhkan gejala sensorik seperti baal, nyeri atau kesemutan, dan sebanyak 6% keluhan motorik berupa kram atau kelemahan otot.…”