Pain management in patients with haemophilia: a European survey.

TY - JOUR

T1 - Pain management in patients with haemophilia: a European survey.

AU - Holstein, Katharina

AU - Klamroth, R

AU - Richards, M

AU - Carvalho, M

AU - Pérez-Garrido, R

AU - Gringeri, A

AU - Board, European Haemophilia Therapy Standardization

PY - 2012

Y1 - 2012

N2 - There are no evidence-based guidelines on pain management in people with haemophilia (PWH), who may suffer acute, disabling pain from haemarthroses and chronic arthropathic pain. To review evidence and to investigate current clinical practice in pain assessment and management in PWH the European Haemophilia Therapy Standardisation Board undertook a literature review and a survey in 22 Haemophilia Treatment Centres (HTC), using a questionnaire and seven clinical scenarios. Consensus was sought on pain assessment and management in PWH. Few clinical studies on pain management in PWH were identified. The HTCs care for 1678 children (47% severe haemophilia, 84% on prophylaxis, 17% with arthropathy and 8% with chronic pain) and 5103 adults (44% severe haemophilia, 40% on prophylaxis, 67% with arthropathy and 35% with chronic pain). Analgesics are prescribed by HTCs in 80% of cases (median; range 0-100%) and in 10% (median; range 0-80%) are bought over the counter. Pain and analgesic use are assessed when reported by patients and at check-ups. Only eight centres use a specific pain scale and/or have specific pain guidelines. Two HTCs arrange regular consultations with pain specialists. For acute pain, the preferred first-line drug is paracetamol for children, and paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for adults. Children with chronic pain are treated with paracetamol or NSAIDs, whereas adults usually receive Cox-2 inhibitors. Second-line therapy is heterogeneous. There is little published evidence to guide pain assessment and management in PWH, and clinical practice varies considerably across Europe. General and specific recommendations are needed.

AB - There are no evidence-based guidelines on pain management in people with haemophilia (PWH), who may suffer acute, disabling pain from haemarthroses and chronic arthropathic pain. To review evidence and to investigate current clinical practice in pain assessment and management in PWH the European Haemophilia Therapy Standardisation Board undertook a literature review and a survey in 22 Haemophilia Treatment Centres (HTC), using a questionnaire and seven clinical scenarios. Consensus was sought on pain assessment and management in PWH. Few clinical studies on pain management in PWH were identified. The HTCs care for 1678 children (47% severe haemophilia, 84% on prophylaxis, 17% with arthropathy and 8% with chronic pain) and 5103 adults (44% severe haemophilia, 40% on prophylaxis, 67% with arthropathy and 35% with chronic pain). Analgesics are prescribed by HTCs in 80% of cases (median; range 0-100%) and in 10% (median; range 0-80%) are bought over the counter. Pain and analgesic use are assessed when reported by patients and at check-ups. Only eight centres use a specific pain scale and/or have specific pain guidelines. Two HTCs arrange regular consultations with pain specialists. For acute pain, the preferred first-line drug is paracetamol for children, and paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for adults. Children with chronic pain are treated with paracetamol or NSAIDs, whereas adults usually receive Cox-2 inhibitors. Second-line therapy is heterogeneous. There is little published evidence to guide pain assessment and management in PWH, and clinical practice varies considerably across Europe. General and specific recommendations are needed.

KW - Adult

KW - Humans

KW - Male

KW - Aged

KW - Questionnaires

KW - Europe

KW - Pain Measurement

KW - Child

KW - Consensus

KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use

KW - Acetaminophen/therapeutic use

KW - Analgesics, Opioid/therapeutic use

KW - Cyclooxygenase 2 Inhibitors/therapeutic use

KW - Hemophilia A/drug therapy/physiopathology

KW - Pain Management/methods

KW - Adult

KW - Humans

KW - Male

KW - Aged

KW - Questionnaires

KW - Europe

KW - Pain Measurement

KW - Child

KW - Consensus

KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use

KW - Acetaminophen/therapeutic use

KW - Analgesics, Opioid/therapeutic use

KW - Cyclooxygenase 2 Inhibitors/therapeutic use

KW - Hemophilia A/drug therapy/physiopathology

KW - Pain Management/methods

M3 - SCORING: Journal article

VL - 18

SP - 743

EP - 752

JO - HAEMOPHILIA

JF - HAEMOPHILIA

SN - 1351-8216

IS - 5

M1 - 5

ER -