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. 2021 Jul;19(4):335-342.
doi: 10.2450/2020.0085-20. Epub 2020 Nov 27.

Pain assessment and management in Italian Haemophilia Centres

Matteo N D Di Minno  1 , Cristina Santoro  2 , Antonio Corcione  3 , Giovanni Di Minno  4 , Marco Martinelli  5 , Maria E Mancuso  6 , Benedetto Acone  7 , Angelo C Molinari  8 , Emilio V Passeri  5 , Angiola Rocino  9 , Rita C Santoro  10 , Annarita Tagliaferri  11 , Consalvo Mattia  12 ; HAEMODOL Study Group (Appendix 1)
Affiliations

Pain assessment and management in Italian Haemophilia Centres

Matteo N D Di Minno et al. Blood Transfus. 2021 Jul.

Abstract

Background: Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop degenerative joint changes, associated with significant pain. The aim of this survey was to investigate the management and perception of pain among Italian physicians who treat PWH.

Materials and methods: Between September and October 2017, a questionnaire was distributed to 35 Italian haemophilia treatment centres (60 physicians).

Results: Fifty-three haemophilia specialists completed the survey. We found that there was good agreement (98.1%) on the need to investigate pain at each clinical visit, but there was heterogeneity in the opinions of haemophilia specialists with regards to the availability of validated guidelines (35.8%) and whether pain specialists should be a part of the comprehensive care team in daily clinical practice (58.5%). Haemophilia specialists also agreed pain should be evaluated using a rating scale validated in PWH (88.7%). Pain was mainly managed by the haemophilia specialists themselves, supported by a physiatrist and physiotherapist, while a pain specialist was only involved in 26.4% of cases. The combination of paracetamol with tramadol or codeine was the most common first-line treatment, while cyclo-oxygenase-2 inhibitors, non-steroidal anti-inflammatory drugs, and opioids were less commonly used.

Discussion: There are some unmet needs in Italy regarding pain management for PWH and the management of pain in these patients by haemophilia specialists. There is a lack of evidence-based guidelines for these specialists to use, as well as a reluctance to involve pain specialists. The lack of spontaneous reporting of pain by PWH, despite using pain relief, highlights the need for clinicians to actively ask patients about any pain they may be experiencing.

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Conflict of interest statement

DISCLOSURE OF CONFLICTS OF INTEREST

MNDDM has received grants and honoraria from Bayer, Pfizer, Sobi, and Novo Nordisk. CS has acted as a paid consultant to Bayer, Shire, Pfizer, Sobi, Novo Nordisk, Roche, Novartis, and Amgen. GDM has acted as a paid consultant to Novo Nordisk, Pfizer, Kedrion, Bayer, CSL Behring, and Roche. MEM has acted as a paid consultant to Bayer Healthcare, CSL Behring, Novo Nordisk, Pfizer, Sobi/Biogen, Bioverativ, Roche, Octapharma, Grifols, and Kedrion. ACM has acted as a paid consultant to Bayer, CSL, Kedrion, Novo Nordisk, Pfizer, Roche, Shire, and Sobi, and as a paid invited speaker for Bayer, CSL, Novo Nordisk, Shire, and Sobi. AR has acted as a paid consultant to Bayer, CSL Behring, Kedrion, Shire, Novo Nordisk, Pfizer, Sobi, and Roche, and as a paid invited speaker for the same companies. RCS has acted as a paid consultant to Bayer, Shire, Sobi, Roche, and CSL Behring. AT has acted as a member of advisory boards for Bayer, Novo Nordisk, and Roche, and as a paid invited speaker for Novo Nordisk. CM has acted as a paid consultant to Sobi, Merck, Sandoz, and Grünenthal. The other Authors report no conflicts of interest.

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