The Pain Trajectory for the Bleeding Disorder Patient
Pain is an under-managed, misunderstood and often under-recognized issue in the bleeding disorder population. The biggest concern is prompt recognition of what’s causing the pain, what level of damage there is, and applying the correct methods to manage the pain. There is not only the initial bleed and the pain associated with the inflammation it causes, but also the chronic damage from blood going into the joints repeatedly. Blood is considered very acidic outside of its vessels. When blood is released into the joint, it becomes inflamed and triggers a message to the brain that there is tissue damage. This is referred to as a nociceptive pain message, which is defined as a response to a painful stimuli. Over a long period of time, these messages lead to development of fibrosis and diseases within the joint, known as arthropathies. Chronic nerve changes also occur within these compartments. This leads to a much more magnified pain message, what we refer to as a neuropathic pain state.
Both mechanisms of pain should be addressed when choosing the best methods of treatment. Nociceptive pain can be managed by safer categories of analgesics and opioids. Auxillary medications, such as antidepressants, are used primarily for neuropathic pain. Methadone is a common drug that is considered an opioid, but also effective for neuropathic pain; thus it is being used more readily for bleeding disorder patients.
There is also the emotional/psychological impact. Physiologically, the pain message ascends into our brain and is perceived in our limbic system, which is basically our emotional center. It’s where moods come from, as well as appetite, sexual desires, REM-cycle sleep patterns and more. If there is a constant negative input into that limbic system, it affects the patient’s entire outlook. There’s a great correlation between depression, fatigue, decreased appetite and isolation. When you aggressively and properly manage the pain, you’ll actually see a change in these emotional outputs.
The philosophy behind proper pain management is that pain is an actual disease state and needs to be addressed in that manner. Pain is no longer considered a symptom to the condition we battle; rather, it is considered an independent, though parallel disease state that compounds the underlying disease. When pain is left unrelieved, you can actually see remodeling of the nervous system in relationship to the pain input.
The proper management of pain for patients with bleeding disorders will dramatically affect the perceived outcomes for patients and positively promote patient satisfaction and overall quality of life.
