Comprehensive management of chronic pain in haemophilia

Abstract

Chronic pain, most often due to haemophilic arthropathy, is a pervasive problem in persons with haemophilia (PWH) that adversely impacts function and quality of life. PWH with inhibitors and older PWH may be especially vulnerable to progressive arthropathy and resulting chronic pain. The development of chronic pain from acute pain involves a complex interplay of biological and psychosocial factors that may all contribute to the perpetuation of chronic pain and the outcome of therapy. In the absence of evidence-based guidelines, an individualized, multimodal approach to chronic pain management is proposed, as it is in individuals without haemophilia who have chronic pain. Pharmacological treatment is central to the management of chronic pain and must be modified based on pain intensity, ongoing response to therapy and the risk for adverse events. Non-pharmacological interventions, including physiotherapy, complementary treatments and surgical (e.g. orthopaedic) or other invasive procedures, may be integral to chronic pain management in this population. Ongoing psychosocial assessment is critical to identify those factors that may be contributing to the perpetuation of chronic pain or acting as barriers to effective management. Additional study is needed to identify optimal pharmacological treatments for chronic pain in PWH based on the unique pathophysiology of haemophilic arthropathy and on risk profile. Systematic determination of the particular psychosocial factors impacting the experience and management of chronic pain in PWH would likewise add value to the treatment of this pervasive problem.

Assessment and management of pain in children and adolescents with bleeding disorders: a cross‐sectional study from three haemophilia centres

“…Young et al . stated that ‘caretaker education is critical to facilitate proactive disclosure of chronic pain and to ensure appropriate responses to and management of pain.’ The results of this study suggest that this education remains missing in parental education about haemophilia management .…”

Differentiating between signs of intra‐articular joint bleeding and chronic arthropathy in haemophilia: a narrative review of the literature

“…In a study by Wallny et al [21], 43% of the respondents states that chronic pain was relieved by using clotting factor replacement treatment, whereas in 26% pain was sufficiently relieved with analgesic drugs combined with clotting factor replacement treatment. This might contribute to the finding that some patients use clotting factor to alleviate chronic pain, whereas analgesic drugs and physiotherapy treatment seem to be more appropriate [22,23]. In this study, several patients mention an analgesic effect of clotting factor replacement.…”

Pain assessment and management in haemophilia: A survey among Italian patients and specialist physicians

“…Despite the relevant burden of pain in PWH, only few clinical studies have investigated the non‐pharmacological or pharmacological treatments for pain or the adverse effects of pain on the health and quality of life in this population. Therefore, evidence‐based and agreed algorithms or guidelines for pain management in PWH are an unmet need for the haemophilia community, although several expert opinion and reviews have been published . In this scenario, the aim of this survey was to describe the perception of pain, its current assessment and management in PWH in Italy, from both the patients’ and physicians’ perspective.…”