Psychophysical assessment of pain in adults with moderate and severe haemophilia: A cross-sectional study

BackgroundJoint pain is the hallmark of haemophilia; therefore it seems clinically rather a musculoskeletal than a bleeding disorder. Although joint pain in people with haemophilia (PwH) is a complex and multidimensional problem, pain assessment remains primarily focused on the structural evaluation of their joints. Whereas, only few data are available on the potential implication of psychophysical and psychological factors. ObjectiveThis study aimed to perform a psychophysical pain assessment including quantitative sensory testing (QST) and an evaluation of psychological factors in a large sample of PwH, to get insight into the individuals' pain system. MethodsNinety-nine adults (36.9 & PLUSMN; 13.5 years) with moderate/severe haemophilia A/B and 46 healthy controls filled in self-reported pain and psychological questionnaires and underwent a QST evaluation including static and dynamic tests. Static tests focused on the determination of thermal detection and pain thresholds and mechanical pressure pain thresholds. Dynamic tests evaluated pain facilitation and the efficacy of endogenous pain inhibition. Besides comparing PwH and healthy controls, between-subgroup differences were studied in PwH based on their pain distribution. ResultsThe study revealed increased thermal and mechanical pain sensitivity and the presence of unhelpful psychological factors such as anxiety/depression in PwH. Among the subgroups, especially PwH with widespread pain showed altered somatosensory functioning. Enhanced pain facilitation and impaired efficacy of endogenous pain inhibition in PwH could not be observed. ConclusionAltered somatosensory functioning and unhelpful psychological factors, appear to play an important role in the pathophysiology of pain in PwH, especially in PwH with widespread pain.

Automated summary

This study aimed to evaluate psychophysical pain assessment and psychological factors in a large sample of people with haemophilia. The results showed that people with haemophilia had increased thermal and mechanical pain sensitivity and experienced unhelpful psychological factors such as anxiety/depression. Altered somatosensory functioning and psychological factors appear to be important in the pathophysiology of pain in people with haemophilia, especially for those with widespread pain.