A combination of drugs acting on different points of the pain pathway may be beneficial in reducing joint pain in people with hemophilia, according to a review article published in the journal Blood Coagulation and Fibrinolysis.
Non-pharmacological measures may also help patients, such as active coping strategies including rest, ice, compression and elevation, as well as complementary therapies and physiotherapy, according to the authors of the article titled “Pain and pain management in hemophilia.”
“Whichever treatment option is chosen, it is important to monitor pain and adjust patient management if necessary,” wrote Dr. Günter Auerswalda, director of the Institute for Hemophilia and Thrombosis at Hess Children’s Hospital in the Klinikum Bremen, Germany, and the co-authors of the review.
Hemophilia patients often experience joint pain. This can be acute or chronic and may vary from one person to another because of each patients’ experiences and response to pain. According to Auerswalda and colleagues, a personalized approach to pain management is necessary.
The first intervention against pain is often the prevention of bleeding, which may help reduce bleeding-related pain. This can be done via factor replacement therapy, where the missing blood-clotting factor (factors VIII or IX) is provided to the patient. Or, bleeding can be prevented by using bypassing therapy, in which agents bypass the need for factor VIII or IX.
Another option is to use analgesics or painkillers. A large array of painkillers that can be effective against joint pain exist, but “consideration should be paid to the adverse effects of each class,” according to the authors.
Finally, joint aspiration could be performed in an attempt to reduce acute joint pain, and joint steroid injections may alleviate chronic pain.
If pain persists in the long term, surgery may be necessary to correct the effect of repeated bleeding on certain organs and tissues and this may help reduce pain.
Bleeding into the joints and muscles is extremely painful and accounts for 70 to 80 percent of all bleeding in patients with severe hemophilia. Repeated bleeding into the joints can cause joint deformities that may become fixed over time. It can also trigger inflammation and progressive damage to the joint cartilage, which may impact bone health and result in more pain and reduced quality of life. It’s important to monitor patients and manage their pain effectively.
“Further study is needed to improve our understanding of the complex interplay of factors influencing pain perception and management in hemophilia patients across the age spectrum,” the authors concluded.