title: Assessment of acute and persistent pain management in patients with haemophilia.
abstract: A descriptive survey was conducted in Region V-E of the United States to bridge the gap in available information on pain issues in the bleeding disorders population. The aim of this study was to a) determine language used by patients to describe and differentiate acute and persistent pain, b) describe pharmacological and non-pharmacological strategies utilized to control pain, c) determine the providers of pain management to this population and d) evaluate quality of life incorporating the SF-36 QOL tool. A total of 202 surveys were returned. For the purposes of this paper, it was decided to analyse only haemophilia data (n = 114). Average persistent daily pain levels were 5/10 (P < 0.001). The three most common word descriptors for both acute and persistent pain were the same - achy, throbbing and tender; the most utilized pain medications were NSAIDs and acetaminophen. Factor replacement was used for what respondents described as acute pain management 79% of the time and for persistent pain management 38% of the time. Participants described acute and persistent pain with the same pain descriptors leading to the conclusion that patients have difficulty distinguishing between acute and persistent pain. This lack of differentiation was further displayed by the use of factor replacement to treat persistent pain associated with arthritic discomfort (38%) which would be viewed as inappropriate, as well as lack of factor replacement use by 21% of respondents who identified pain as from an acute bleed. Opportunities exist to improve pain management through patient and provider-directed educational programs.
authors.affiliation: Northern Regional Bleeding Disorders Center, Traverse City, MI, USA. mwitkop@mhc.net
authors.forename: M
authors.initials: M
authors.lastname: Witkop
authors.forename: A
authors.initials: A
authors.lastname: Lambing
authors.forename: E
authors.initials: E
authors.lastname: Kachalsky
authors.forename: G
authors.initials: G
authors.lastname: Divine
authors.forename: D
authors.initials: D
authors.lastname: Rushlow
authors.forename: J
authors.initials: J
authors.lastname: Dinnen
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D000529:Complementary Therapies; D005260:Female; D006467:Hemophilia A / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000628:therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011788:Quality of Life; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001779:Blood Coagulation Factors; D000082:Acetaminophen