Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

Gualtierotti, Roberta; Tafuri, F.; Arcudi, Sara; Solimeno, Pier Luigi; Acquati, Jacopo; Landi, Laura; Peyvandi, Flora

doi:10.1007/s40122-021-00345-x

Cited by 10 publications

(7 citation statements)

References 96 publications

(127 reference statements)

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“…Obstetric management for women with vWD, hemophilia carriers and those with inherited platelet disorders requires counselling (preferably before conception), choice, informed consent and multidisciplinary care providers ( Table 3 , 2 , 59 Table 6 , 2 , 40 , 59 , 72 – 81 Table 7 , 2 , 40 , 59 , 72 – 81 Table 8 42 , 82 – 90 ). There are substantial hemostatic changes in a normal pregnancy whose role is to preserve placental function and prevent excessive bleeding at delivery.…”

Section: Managementmentioning

confidence: 99%

Preoperative diagnosis and management of inherited bleeding disorders in female adolescents and adults

Wilson

2023

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Although inherited bleeding disorders (IBDs) affect both females and males, this review of the preoperative diagnosis and management of IBDs focuses on genetic and gynecologic screening, diagnosis and management of affected and carrier females. A PubMed literature search was conducted, and the peer-reviewed literature on IBDs was evaluated and summarized. Best-practice considerations for screening, diagnosis and management of IBDs in female adolescents and adults, with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence level and ranking of recommendation strength, are presented. Health care providers need to increase their recognition of and support for female adolescents and adults with IBDs. Improved access to counselling, screening, testing and hemostatic management is also required. Patients should be educated and encouraged to report abnormal bleeding symptoms to their health care provider when they have a concern. It is hoped that this review of preoperative IBD diagnosis and management will enhance access to women-centred care to increase patients’ understanding of IBDs and decrease their risk of IBD-related morbidity and mortality.

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Section: Managementmentioning

confidence: 99%

Preoperative diagnosis and management of inherited bleeding disorders in female adolescents and adults

Wilson

2023

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“…Acute pain in hemophilia is associated with the development of joint bleeding, although imaging techniques have shown how it can develop in the absence of hemarthrosis. 58 Acute pain linked to hemarthrosis and, therefore, clearly having a nociceptive mechanism, is treated conservatively according to the RICE protocol (Rest, Ice, Compression, Elevation). This approach does not differ from that used in most acute injuries that involve bleeding or swelling.…”

Section: Evaluation and Approach Of Pain In Patients With Hemophiliamentioning

confidence: 99%

“…However, doubts have been raised on the use of ice due to its interference in the clotting process. 58 Along with the administration of clotting factor replacement, the administration of analgesic drugs (paracetamol, acetaminophen, COX-2 inhibitors) and, where indicated, arthrocentesis is recommended to reduce bleeding as soon as possible. 55 The pharmacological approach to chronic pain includes the use of antidepressants, antiepileptic drugs, NSAIDS, opioids and paracetamol.…”

Section: Evaluation and Approach Of Pain In Patients With Hemophiliamentioning

confidence: 99%

Hemophilic Arthropathy: Barriers to Early Diagnosis and Management

Cuesta‐Barriuso¹,

Donoso-Úbeda²,

Meroño-Gallut³

et al. 2022

JBM

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Hemophilia is a congenital coagulopathy characterized by a deficiency of one of the clotting factors. It is characterized by the development of hematomas and hemarthrosis, either spontaneously or after minor trauma. The recurrence of hemarthroses leads to progressive and degenerative joint damage from childhood (hemophilic arthropathy). This arthropathy is characterized by disabling physical effects that limit the functionality and quality of life of these patients. Medical progress achieved over the last decade in the drug treatment of hemophilia has improved the medium and long-term prospects of patients with more effective and long-lasting drugs. The universal use of safer, more effective and prolonged prophylactic treatments may promote the prevention of bleeding, and also therefore, of the development of hemarthrosis and joint damage. A number of imaging instruments have been developed for the assessment of hemarthrosis and hemophilic arthropathy, using ultrasound, magnetic resonance imaging and simple radiology. Different physical examination scores and questionnaires allow the assessment of joint health, self-perceived activity and functionality of patients with hemophilia. The approach to these patients should be interdisciplinary. Assessment of the processes that affect pain in these patients and the development of pain education models should be implemented. Expert advice and information to patients with hemophilia should be based on individual functional prevention diagnoses, advice on available therapies and sports practice, as well as health recommendations.

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“…This narrative review aims to give healthcare professionals (HCPs) a clear picture of current knowledge, hence favouring the optimisation of clinical management of pain. It is worth noting that the main focus of this narrative review is the evaluation of pain in PWH and not its treatment (read as, available pharmacological and non‐pharmacological therapies), which have been recently and widely reviewed elsewhere 18,21 …”

Section: Introductionmentioning

confidence: 99%

The good, the bad and the ugly of pain in haemophilia: Recent evidence on the epidemiology, molecular mechanisms and knowledge gaps preventing optimal treatment

Benemei,

Mattia,

Di Minno

2024

Haemophilia

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IntroductionHaemophilia is an inherited, X‐linked blood clotting disorder caused by the deficiency of coagulation factors VIII (FVIII, haemophilia A) or IX (FIX, haemophilia B). Spontaneous bleeds are common in severe forms of haemophilia and can also occur in moderate and mild haemophilia. Severe or repeated bleeding at a joint can evolve into chronic haemophilic arthropathy, with functional damage of the joint, disability, and intense chronic articular pain. Nonetheless, acute and chronic pain may emerge due to secondary conditions related to bleedings.AimThis narrative review aims to critically discuss the most recent evidence about pain in haemophilia to give healthcare professionals a clear picture of current knowledge hence favouring the optimisation of clinical management of pain.MethodsExtensive literature search with the terms ‘hemophilia’ AND ‘pain’, focusing on the time window 2021–2023.ResultsAcute and chronic pain is a critical aspect of haemophilia at all ages. It should be considered a multifaceted phenomenon, with a positive role as an early emergency signal of a clinical event (haemarthrosis), and numerous detrimental aspects linked to its burden that heavily affects the health‐related quality of life, with psychological and social consequences.ConclusionDespite its prevalence and frequency in people with haemophilia, pain is often underestimated by healthcare professionals, leading to insufficient and inadequate treatment, also due to uncertainty linked to the presence of the coagulation disorder or arthritic flares.

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Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

Cited by 10 publications

References 96 publications

Preoperative diagnosis and management of inherited bleeding disorders in female adolescents and adults

Preoperative diagnosis and management of inherited bleeding disorders in female adolescents and adults

Hemophilic Arthropathy: Barriers to Early Diagnosis and Management

The good, the bad and the ugly of pain in haemophilia: Recent evidence on the epidemiology, molecular mechanisms and knowledge gaps preventing optimal treatment

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