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2016 ; 27
(8
): 845-854
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Pain and pain management in haemophilia
#MMPMID27439216
Auerswald G
; Dolan G
; Duffy A
; Hermans C
; Jiménez-Yuste V
; Ljung R
; Morfini M
; Lambert T
; ?alek SZ
Blood Coagul Fibrinolysis
2016[Dec]; 27
(8
): 845-854
PMID27439216
show ga
Joint pain is common in haemophilia and may be acute or chronic. Effective pain
management in haemophilia is essential to reduce the burden that pain imposes on
patients. However, the choice of appropriate pain-relieving measures is
challenging, as there is a complex interplay of factors affecting pain
perception. This can manifest as differences in patients' experiences and
response to pain, which require an individualized approach to pain management.
Prophylaxis with factor replacement reduces the likelihood of bleeds and
bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and
pain relief. Although use of replacement or bypassing therapy is often the first
intervention for pain, additional pain relief strategies may be required. There
is an array of analgesic options, but consideration should be paid to the adverse
effects of each class. Nevertheless, a combination of medications that act at
different points in the pain pathway may be beneficial. Nonpharmacological
measures may also help patients and include active coping strategies; rest, ice,
compression, and elevation; complementary therapies; and physiotherapy. Joint
aspiration may also reduce acute joint pain, and joint steroid injections may
alleviate chronic pain. In the longer term, increasing use of prophylaxis or
performing surgery may be necessary to reduce the burden of pain caused by the
degenerative effects of repeated bleeds. Whichever treatment option is chosen, it
is important to monitor pain and adjust patient management accordingly. Beyond
specific pain management approaches, ongoing collaboration between
multidisciplinary teams, which should include physiotherapists and pain
specialists, may improve outcomes for patients.