Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain.
Expert Rev Hematol. 2021 Jun;14(6):525-535. doi: 10.1080/17474086.2021.1935852. Epub 2021 Jun 14.
: People with hemophilia (PWH) commonly experience acute and chronic musculoskeletal pain during childhood and young adulthood, but their treatment is often inadequate.: From 1 September 2020 to 15 April 2021, authors performed a literature search in PubMed and the Cochrane Library using 'hemophilia AND pain' as keywords. Authors found 1082 articles, 51 of which were chosen because we considered them to be intimately connected with the topic of this report. Multimodal pain treatment, including multimodal analgesia, physical and rehabilitation medicine (PRM), and psychological therapies (imagery or relaxation, hypnosis), is currently the most recommended treatment for PWH. In acute hemarthrosis, in addition to hematologic treatment and joint aspiration, paracetamol/acetaminophen should be prescribed if the pain is mild, metamizole if the pain is moderate, and soft opioids (codeine or tramadol) if the pain is severe. In cases of chronic musculoskeletal pain due to hemophilic arthropathy, paracetamol/acetaminophen, COX-2 inhibitors, PRM, intra-articular injections of some drugs (corticosteroids, hyaluronic acid, platelet-rich plasma, mesenchymal stem cells), radiosynovectomy and behavioral therapies are advised.: Management of musculoskeletal pain in children and young adults with hemophilia should employ multimodal pain treatment (multimodal analgesia, PRM, and psychological strategies).
: 患有血友病（PWH）的人在儿童和青年时期经常会经历急性和慢性肌肉骨骼疼痛，但他们的治疗往往不足。: 从 2020 年 9 月 1 日至 2021 年 4 月 15 日，作者在 PubMed 和 Cochrane Library 中使用“hemophilia AND pain”作为关键字进行了文献检索。作者找到了 1082 篇文章，其中 51 篇被选中，因为我们认为它们与本报告的主题密切相关。多模式疼痛治疗，包括多模式镇痛、物理和康复医学（PRM）以及心理治疗（意象或放松、催眠），是目前最推荐的 PWH 治疗方法。在急性关节积血中，除了血液学治疗和关节抽吸外，如果疼痛轻微，应开扑热息痛/对乙酰氨基酚；如果疼痛中度，应开甲灭酸；如果疼痛严重，应开软阿片类药物（可待因或曲马多）。对于血友病性关节炎引起的慢性肌肉骨骼疼痛，建议使用扑热息痛/对乙酰氨基酚、COX-2 抑制剂、PRM、关节内注射一些药物（皮质类固醇、透明质酸、富血小板血浆、间充质干细胞）、放射滑膜切除术和行为疗法。: 儿童和青年血友病患者肌肉骨骼疼痛的管理应采用多模式疼痛治疗（多模式镇痛、PRM 和心理策略）。
