Pain in hemophilia patients: Assessment and management in a fourth level hospital. Case series
Up to 80% of hemophilia patients present acute and chronic pain, mostly secondary to joint involvement. In Colombia there are no studies on the topic.
To show the epidemiological profile, assessment and management of these patients in a referral hospital for the treatment of hemophilia.
Observational descriptive study, based on case series. Patients older than18 years with diagnosis of hemophilia who were evaluated between January 1st, 2013 and March 31st, 2016 were included. The qualitative variables were described with absolute frequencies and the quantitative variables with means.
196 hemophilia patients were registered in the trial; 87%, males and13% females; the average age was 39 years. Hemophilia A 79%, hemophilia B18%, carriers 3%. The causes for admission were 45% surgical,37% medical and17% trauma. The average hospital stay was 8 days (range 1-58) and 2 hospital admission per year (range 1-5). No pain evaluation scales were used in 71% of the cases and 29% were administered the Visual Analogue Scale. Opioids were prescribed in 58% of cases, acetaminophen in 67%, and pregabalin in 5.6%. Only 33 patients were treated by the pain clinic.
Notwithstanding the presence of pain and the frequency of functional sequelae among hemophilia patients, most of them were not assessed by the pain clinic and no pain evaluation scales were used. The pharmacological management was based on the prescription of opioids and acetaminophen.
2. John L, Butler S. In: John L, editor. Bonica: Terapeutica Del Dolor. México: McGraw Hill; 2003.
3. Riley RR, Witkop M, Hellman E, Akins S. Assessment and management of pain in haemophilia patients. Haemophilia. 2011;17:1-7.
4. Aleti G, Arbesú G, Baques A, Beligoy M, Perez-Bianco R, Bordone R. Guía de Tratamiento de La Hemofilia. In: Consenso de Médicos Especialistas En Hemofilia de La República Argentina. 2011.
5. Aguilar JL, Guanyabens C, March Y, Serra A, Valentí P, Pedrero A, et al. El dolor en el enfermo hematológico: cuidados paliativos integrales. Rev Soc Esp Dolor. 1999;6:436-48.
6. Acharya SS. Exploration of the pathogenesis of haemophilic joint arthropathy: understanding implications for optimal clinical management. Br J Haematol. 2012;156:13-23.
7. Humphries T, Kessler C. Managing chronic pain in adults with haemophilia: current status and call to action. Haemophilia. 2015;21:41-51.
8. Arranz P, Remor E, Quintana M, Villar J, Diaz JL, Moreno M, et al. Disease specific quality of life questionnaire to adults living with haemophilia. Haemophilia. 2004;10:376-82.
9. Lambing A, Kohn-Converse B, Hanagavadi S, Varma V. Use of acupuncture in the management of chronich aemophilia pain. Haemophilia. 2012;18:613-7.
10. Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Efficacy of celecoxib in the treatment of joint pain caused by advanced haemophilic arthropathy in adult patients with haemophilia A. Haemophilia. 2014;20:e225-7.
11. Teyssler P, Kolostova K, Bobek V. Assessment of pain threshold in haemophilic patients. Haemophilia. 2014;20:207-11.
12. Caicedo MV, Raffan-Sanabria F, Duarte-Romero M. Manejo perioperatorio del paciente hemofílico. Rev Mex Anestesiol. 2009;32:177-85.
13. Acunia L, Sanchez P, Soler L, Alvis L, Acunna L, Sanchez P, editors. La Situacion de La Hemofilia En Colombia: 2015. Fondo Colombiano de enfermedades de alto costo; 2015. p. 28-59 [Internet]. Available from en: https://cuentadealtocosto.org [cited 2015].
14. Holstein K, Klamroth R, Richards M, Carvalho M, Pérez-Garrido R, Gringeri A. Pain management in patients with haemophilia: a European survey. Haemophilia. 2012;18:743-52.
15. Witkop M, Lambing A, Divine G, Kachalsky E, Rushlow D, Dinnen J. A national study of pain in the bleeding disorders community: a description of haemophilia pain. Haemophilia. 2012;18:e115-9.
16. Elander J, Robinso G. A brief haemophilia pain coping questionnaire. Haemophilia. 2008;14:1039-48.
17. Poon JL, Zhou ZY, Doctor JN, Ullman MM, Ross C, Riske B, et al. Quality of life in haemophilia A: Hemophilia Utilization Group Study Va (HUGS-Va). Haemophilia. 2012;18:699-707.
18. Feldman BM, Funk SM, Bergstrom BM, Zourikian N, Hilliard P, Van Der Net J, et al. Validation of a new pediatric joint scoring system from the international hemophilia prophylaxis study group: validity of the hemophilia joint health score. Arthritis Care Res. 2011;63:223-30.
19. Witkop M, Lambing A, Kachalsky E, Divine G, Rushlow D, Dinnen J. Assessmen of acute and persistent pain management in patients with haemophilia. Haemophilia. 2011;17:612-9.
20. Elander J, Robinson G, Mitchell K, Morris J. An assessment of the relative influence of pain coping, negative thoughts about pain, and pain acceptance on health-related quality of life among people with hemophilia. Pain. 2009; 145(1-2):169-75.
21. Ceponis A, Wong-Sefidan I, Glass CS, von Drygalski A. Rapid musculoskeletal ultrasound for painful episodes in adult haemophilia patients. Haemophilia. 2013;19:790-8.
22. Van Genderen FR, Fischer K, Heijnen L, De kleijn P, Van Den Berg HM, Helders PJM, et al. Pain and functional limitations in patients with severe haemophilia. Haemophilia. 2006;12:147-53.
23. Rolstad EB. Perceptions of men with moderate to severe hemophilia regarding the management of their chronic disorder and utilization of community-based support. Am J Mens Heal. 2015;9. SP-486-95.
24. Young G, Tachdjian R, Baumann K, Panopoulos G. Comprehensive management of chronic pain in haemophilia. Haemophilia. 2014;20:e113-20.
25. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Physiotherapy treatment in patients with hemophilia and chronic ankle arthropathy: a systematic review. Rehabil Res Pr. 2013;2013:305249.
26. Everett R, Ahmed S, Laffan M. Abdominal pain in a patient with haemophilia and metallic valve replacement. Haemophilia. 2012;18:e370-1.
27. Hilberg T, Czepa D, Freialdenhoven D, Boettger MK. Joint pain in people with hemophilia depends on joint status. Pain. 2011;152:2029-35.