Varni J W
Arch Phys Med Rehabil. 1981 Apr;62(4):183-7.
Hemophilia represents a congenital hereditary disorder of blood coagulation characterized by recurrent unpredictable bleeding episodes affecting any body part, especially the joints and extremities. Repeated hemarthrosis eventually results in degenerative arthritis accompanied by severe chronic pain. As contrast to acute bleeding pain, which serves as a functional signal, chronic arthritic pain is a debilitating condition often resulting in analgesic abuse and/or addiction. Two adult hemophiliacs with severe chronic arthritis received training in progressive muscle relaxation exercise, meditative breathing, and imagery associated with past experiences of pain reduction. Imagery training resulted in clinically significant reductions in arthritic pain perception for both patients, maintained over an 8-month follow-up period. Concomitant Measures also demonstrated significant therapeutic gains. Thermal biofeedback assessment of the arthritic joint provided a biophysiological measure of learned temperature control through the imagery techniques. The findings are discussed in relationship to medical observations on the therapeutic value of warming and heat application in the management of arthritic joints, as well as other potential mechanisms which might have contributed in the reduction of arthritic pain perception. Finally, the importance of differentiating between acute bleeding pain management and chronic arthritic pain is emphasized, as well as the necessity of the application of the techniques within an interdisciplinary team setting.
血友病是一种先天性遗传性凝血障碍疾病，其特征是反复出现不可预测的出血发作，可影响身体任何部位，尤其是关节和四肢。反复的关节积血最终会导致退行性关节炎，并伴有严重的慢性疼痛。与作为功能信号的急性出血性疼痛不同，慢性关节炎疼痛是一种使人衰弱的病症，常常导致镇痛药物滥用和/或成瘾。两名患有严重慢性关节炎的成年血友病患者接受了渐进性肌肉放松练习、冥想呼吸以及与过去疼痛减轻经历相关的意象训练。意象训练使两名患者的关节炎疼痛感知在临床上显著降低，并在8个月的随访期内保持稳定。同时采取的措施也显示出显著的治疗效果。对关节炎关节进行的热生物反馈评估提供了一种通过意象技术实现的习得性温度控制的生物生理学测量方法。本文结合关于温热疗法在关节炎关节治疗中的治疗价值的医学观察结果以及可能有助于减轻关节炎疼痛感知的其他潜在机制对研究结果进行了讨论。最后，强调了区分急性出血性疼痛管理和慢性关节炎疼痛的重要性，以及在跨学科团队环境中应用这些技术的必要性。
