Pain and pain management in haemophilia.
Pain and pain management in haemophilia.
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DOI：
10.1097/mbc.0000000000000571
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Šalek SZ
中科院分区：
文献类型：
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作者：
Auerswald G;Dolan G;Duffy A;Hermans C;Jiménez-Yuste V;Ljung R;Morfini M;Lambert T;Šalek SZ
关节疼痛在血友病中很常见，可能是急性的，也可能是慢性的。血友病的有效疼痛管理对于减轻疼痛给患者带来的负担至关重要。然而，选择适当的疼痛缓解措施具有挑战性，因为影响疼痛感知的因素之间存在着复杂的相互作用。这可能表现为患者的经历和对疼痛的反应存在差异，这需要个体化的疼痛管理方法。因子替代预防可减少出血和出血相关疼痛的可能性，而按需治疗可确保快速出血和缓解疼痛。尽管使用替代疗法或旁路疗法通常是疼痛的第一个干预措施，但可能需要额外的疼痛缓解策略。有多种镇痛剂可供选择，但应考虑每种类型的不良反应。尽管如此，作用于疼痛途径不同点的药物组合可能是有益的。非药物措施也可以帮助患者，包括积极的应对策略；休息、冰敷、加压和抬高；补充疗法；和物理治疗。关节抽吸还可以减轻急性关节疼痛，关节类固醇注射可以缓解慢性疼痛。从长远来看，可能需要增加预防措施或进行手术，以减轻反复出血的退行性影响引起的疼痛负担。无论选择哪种治疗方案，监测疼痛并相应调整患者管理都很重要。除了特定的疼痛管理方法之外，包括物理治疗师和疼痛专家在内的多学科团队之间的持续合作可能会改善患者的治疗结果。
Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients.