Neuropathic pain in patients with haemophilia, that is the question

Summary

Chronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

Zusammenfassung

Personen mit Hämophilie (PmH) leiden aufgrund rezidivierender Gelenkblutungen oft unter chronischen Schmerzen. Die Schmerz-ursache, nozizeptiv oder neuropathisch, wurde bisher nicht untersucht. Bei anderen Erkrankungen mit chronischen Schmerzen, wie Arthrose oder rheumatoide Arthritis, konnten Studien neuropathische Schmerzkomponenten nachweisen. 137 PmH und 33 Kontrollen (K) beantworteten den painDETECT-Fragebogen (pDq), der neuropathische Schmerzen identifizieren kann. Basierend auf dem pDq kann ein neuropathischer Schmerz als positiv, negativ oder unklar klassifiziert werden. Ein positives pDq-Ergebnis war bei neun PmH vorhanden, bei 20 PmH war das pDq-Ergebnis unklar. Der Vergleich PwH zu K war statistisch signifikant (p ≤ 0,001). Die Bewertung der Schmerzqualität zeigt bei PmH und K ähnliche Muster, allerdings mit unterschiedlicher Intensität. Bei PmH besteht ein potenzielles Risiko, von einer falschen Schmerz-ursache auszugehen. Bei chronischen Schmerzen, bedingt durch eine hämophilie Arthropathie, scheint eine differenzierte Diagnose unabdingbar, um ein umfassendes und individualisiertes Schmerzmanagement bei PwH zu gewährleisten.

Keywords

Haemophilia - neuropathic - nociceptive - pain

Schlüsselwörter

Hämophilie - neuropathisch - nozizeptiv - Schmerz

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