Matteo N D Di Minno1, Cristina Santoro2, Antonio Corcione3, Giovanni Di Minno4, Marco Martinelli5, Maria E Mancuso6, Benedetto Acone7, Angelo C Molinari8, Emilio V Passeri5, Angiola Rocino9, Rita C Santoro10, Annarita Tagliaferri11, Consalvo Mattia12. 1. Department of Translational Medical Sciences, "Federico II" University, Naples, Italy. 2. Department of Haematology, University Hospital Policlinico Umberto I, Rome, Italy. 3. Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy. 4. Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy. 5. Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy. 6. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Milan, Italy. 7. Cartesio Solutions srl, Venice, Italy. 8. Thrombosis and Haemostasis Unit and Regional Reference Centre for Inherited Bleeding Disorders, "Giannina Gaslini" Children's Hospital, Genoa, Italy. 9. Haemophilia and Thrombosis Centre, Haematology Unit, "Ascalesi" Hospital, Naples, Italy. 10. Haemophilia and Thrombosis Centre, "Pugliese Ciaccio" Hospital, Catanzaro, Italy. 11. Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy. 12. Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine, "Polo Pontino", "Sapienza" University, Rome, Italy.
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.
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.
Authors: Chiara Biasoli; Erminia Baldacci; Antonio Coppola; Raimondo De Cristofaro; Matteo N D Di Minno; Giuseppe Lassandro; Silvia Linari; Maria E Mancuso; Mariasanta Napolitano; Gianluigi Pasta; Angiola Rocino Journal: Blood Transfus Date: 2021-10-15 Impact factor: 3.443
Authors: Matteo Nicola Dario Di Minno; Mariasanta Napolitano; Anna Chiara Giuffrida; Erminia Baldacci; Christian Carulli; Elena Boccalandro; Clarissa Bruno; Eleonora Forneris; Irene Ricca; Walter Passeri; Marco Martinelli; Gianna Franca Rivolta; Luigi Piero Solimeno; Carlo Martinoli; Angiola Rocino; Gianluigi Pasta Journal: Br J Haematol Date: 2021-12-19 Impact factor: 8.615
Authors: Michelle Witkop; Maria Santaella; Cynthia D Nichols; Angela Y Lambing; Kimberly Baumann; Randall G Curtis; Christi Humphrey; Thomas J Humphries; Jennifer Newman; Nancy Durben; Rhonda Fritz; Kimberly Mauer; Constance B Thibodeaux; Emily Wheat; Tyler Buckner Journal: Pain Med Date: 2022-02-01 Impact factor: 3.750