Get access

Comprehensive management of chronic pain in haemophilia

Authors

  • G. Young,

    Corresponding author
    1. Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
    • Correspondence: Guy Young, MD, Director, Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop #54, Los Angeles, CA 90027, USA.

      Tel.: (323) 361 5507; fax: (323) 361 7128;

      e-mail: gyoung@chla.usc.edu

    Search for more papers by this author
  • R. Tachdjian,

    1. Division of Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    Search for more papers by this author
  • K. Baumann,

    1. Center for Bleeding and Clotting Disorders, University of Minnesota, Fairview Medical Center, Minneapolis, MN, USA
    Search for more papers by this author
  • G. Panopoulos

    1. Fairview Pain Management Center, University of Minnesota, Minneapolis, MN, USA
    Search for more papers by this author

Summary

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.

Get access to the full text of this article

Ancillary