Pain Management

About 100 million Americans suffer from chronic pain (also known as persistent pain ) as a result of a variety of diseases and conditions. Pain can be difficult to manage because each person feels and responds to pain differently. In other words, pain is a subjective experience. The way a person feels the pain may be related to several factors.

Biological Factors
• Degree of illness or injury
• Presence of other diseases or conditions
• Genetics: hereditary traits and variations in the human organism
Psychological Factors
• Anxiety, fear, guilt, anger, depression
• To think that the pain is due to something worse than it really is
• Feeling unable to handle pain
Social Factors
• How others near you react to pain
• Work environment or job requirements
• Access to medical care

Cultural Beliefs
The National Institutes of Health (NIH) and other organizations that establish recommendations for health care have begun to recognize the need for more research, education, and guidelines for pain management. Chronic pain can result in anxiety, depression and cholera, and can make management of your bleeding disorder seem even more challenging.

Understanding Types Of Pain

Pain is very common in people with bleeding disorders. Usually people with bleeding disorders rate their daily pain as 5 on a scale of 1 to 10. Unfortunately, the pain is often not handled properly. Although pain can be disquieting and affect your physical and emotional health, you can handle it effectively with the right strategy (or a combination of strategies).

There are two types of pain: acute pain and chronic pain. Being able to identify what kind of pain you are suffering is the first step in deciphering what you can do to relieve it.

Sharp pain. This type of pain is short term (although this means it can last for days or hours) and can be serious. When it is associated with bleeding episodes, it should be treated immediately.
Chronic pain (also known as persistent pain ). This type of pain lasts for months or more and is characterized by continuous discomfort. It is usually the consequence of damage to joints and other parts of the body, possibly because of previous bleeding episodes.

Pain Treatment

The first step in treating your pain is to determine whether you have chronic or acute pain. If you suspect that you have a muscle or joint hemorrhage (one of the causes of acute pain) an infusion of factor may be adequate. However, note that more than one-third of people with bleeding disorders have inadequately treated chronic pain through factor infusions. If you have doubts, you should make an infusion. But if your pain does not improve after an infusion of factor, it may be due to a cause other than bleeding.

RICE Technique

After determining whether or not to make an infusion, you should treat acute pain by means of the acronym RICE: rest, ice, compression and elevation.
Break. Avoid using the affected part of the body for 24 to 48 hours. If you suspect a bleeding, you may also use a splint on the joint to limit its movement.
Ice. Apply ice to the affected area. Ice tightens blood vessels and helps reduce pain and inflammation.
Compression. Use elastic bandages on the affected area. Compression helps reduce pain and prevent bleeding.
Elevation. Keep the affected part of the body elevated. Elevation reduces inflammation.

Over-The-Counter Pain Relievers

You may also want to consider over-the-counter (OTC) or prescription medications to reduce acute pain. Since many painkillers can be harmful to people with bleeding disorders, you must be careful about the ones you use. Non-steroidal anti-inflammatory drugs (NSAIDs) (eg, aspirin, ibuprofen, naproxen) may interfere with clotting by affecting platelet function. Some people with hemophilia may take ibuprofen or naproxen without increasing bleeding, but this should be done under the supervision of their health care providers. Some people use celecoxib, which is a type of prescription NSAID called a COX-2 inhibitor, which does not affect the function of platelets. There are some concerns related to the use of celecoxib because similar medications are associated with an increased risk of heart attacks. These factors should be taken into account before deciding which medication is best for managing the pain.

Acetaminophen is an over-the-counter option for pain management that does not interfere with clotting. However, since prolonged use of acetaminophen can cause liver damage, it should be limited to no more than 4000 milligrams daily if you are 60 years old or less or 3000 milligrams daily if you are over 60 years old. People affected by human immunodeficiency virus (HIV) or hepatitis C (HCV) should consult their health care provider before using acetaminophen.

Prescription Medications

There are prescription drugs to help with short-term pain, and sometimes with chronic pain. These include oxycodone, morphine, methadone and codeine. These medications are effective in many people but can be addictive. They should be used as directed and only under medical supervision.

Other Methods For Pain Management

Chronic pain is often treated with over-the-counter or prescription medications, but there are other strategies that can also be used, such as joint replacement, fusion, or reconstruction. Chronic pain may also respond to physical therapy and exercise.
In addition to keeping your joints and muscles strong and healthy, physical therapy can help reduce pain. Your physiotherapist can design a program specifically for your needs and current health status.
Another possible technique for pain management in people with bleeding disorders is transcutaneous stimulation (TENS). During TENS, a low-voltage electrical current is transmitted through the skin to stimulate the nerves in the affected region. The stimulus, which is not painful, is sufficient to hide the signs of pain.