Pain status in patients with hemophilia: evaluation of routine pain assessment in an unselected cohort of patients with hemophilia A and B

Objective Pain is a common co-morbidity in patients with hemophilia (PWH). Most data on prevalence of pain is generated by patient surveys with potential selection bias or within clinical studies. Therefore, we aimed to analyze prevalence of pain in an unselected cohort of PWH visiting a single German hemophilia center for routine annual check-ups during the previous 4 years.

Material and Methods Assessment of pain intensity (numeric rating scale, NRS, 0 [no pain] to 10 [worst imaginable pain]) and location over the previous 3 months was carried out with an ad-hoc questionnaire. Pain interference was rated on a scale from 0 to 10 with higher values indicating more interference. Impact on mood was reported as none, moderate or severe. Demographic and clinical data were extracted from patient charts.

Results 186 male adult PWH A or B visited the center, of whom 165 (88 %) had a routine annual check-up and 161 (98 %) completed at least 1 questionnaire (94 %, 81 %, 71 % of all PWH with severe, moderate, mild hemophilia, respectively) with a median age at first assessment of 39 years (range, 18-77 years). 145/161 PWH (90 %) reported episodes of pain with a median intensity (NRS) of 6 (range, 1-10), 5 (1-10), 3 (1-9) and median number of affected joints of 2, 2, 1 (range, 0-6) in PWH with severe, moderate, mild hemophilia, respectively. Only 10 % of patients reported no pain and 15 patients (9.7 %) had pain only in locations other than joints. 53 % of PWH with mild hemophilia reported pain. Median pain interference in PWH with pain was rated 4 (range, 0-10); 51, 64, 22 PWH reported no, moderate and severe impact on mood, respectively. Pain intensity correlated with orthopedic joint score (r = 0.426, p<0.001), but was not different between PWH (severe) treated prophylactically or on-demand at time of assessment. Median number of completed questionnaires per patient was 2 (range,1-5) with 93, 48, 13, 2 PWH completing 2, 3, 4, 5 questionnaires, respectively. Median pain intensity was stable over time, indicating that pain is a permanent burden in PWH.

Conclusion This analysis of a routinely used pain assessment tool in an unselected population of PWH A and B reveals a high prevalence of pain episodes, consistent over time, as well as relevant pain interference and impact on mood. The effect of interventions needs to be further analyzed.

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Artikel online veröffentlicht:
18. Juni 2021