Pain Management
Pain is a fairly common complication with hemophilia, but it can generally be managed both by treating the source of the pain (such as bleeding or joint damage) as well as medications and techniques for alleviating the pain itself.
There are two kinds of pain that people with hemophilia may experience:
- Acute pain is caused by active bleeding into a joint or muscle and is usually the earliest sign of a bleed. A bleed that is not treated promptly will go on to stretch a joint or put pressure on muscles and other structures making the pain much worse. Even if there are no other obvious signs of bleeding, such as swelling, clotting factor therapy is recommended.
- Chronic pain is caused by long-term joint damage and typically affects older people with hemophilia who suffer more from arthritis.
The best way to manage pain in hemophilia is to prevent bleeds, and when a bleed does happen, to treat it early. This will decrease the likelihood of experiencing acute pain and prevent the development of joint disease and corresponding chronic pain. If you or a loved one are experiencing acute or chronic pain, your Hemophilia Treatment Centre can help and may refer you to a pain clinic where specialists assess and treat chronic pain. Always discuss your pain management with your healthcare team.
Treating Acute Pain
Pain from a bleed can be controlled by giving clotting factor treatment to stop the bleeding. Use of ice may also reduce acute pain by slowing the blood flow to an area so that the pressure does not build up. Ice will also decrease the ability of the nerves to send pain messages. Supporting the arm or leg on a pillow in a comfortable position or in a splint may help. A relaxing activity or a warm bath can also help to distract from and control the pain.
Are Pain Medications OK?
Medications can be used to relieve hemophilia-related pain. However, many over-the-counter painkillers should NOT be used by people with hemophilia—for example, products that contain aspirin (also called acetylsalicyclic acid, or ASA), which can affect platelet function. Check with your pharmacist, nurse, or doctor about whether the medicine you are considering is safe.
Ice and medication may help to reduce pain, but they do not stop the bleeding. Clotting factor replacement therapy is the only way to stop bleeding. If your or a loved one's regular factor infusion does not seem to relieve the pain, contact your Hemophilia Treatment Centre immediately. It's possible inhibitors have developed that are interfering with treatment, or there may be another reason for the pain, besides a bleed, that is not related to hemophilia.
Treating Chronic Pain
Some people with hemophilia, particularly those with joint damage, suffer from chronic, ongoing pain. There are several options available for the management of chronic pain. A consultation with a physiotherapist is very helpful. They may suggest several pain relief strategies such as exercise, using a walking aid, sprints or braces, transcutaneous electrical nerve simulation (TENS), hydrotherapy, and/or relaxation techniques and biofeedback.