Ways to Control Pain

Prevention and early treatment with factor

Prevent the pain of hemophilia by preventing bleeds.  Take care of yourself by getting the right food, rest, and exercise.  See your doctor for regular check-ups. The best way to reduce pain at the time of the bleed is to treat immediately with factor.  Taking factor will not relieve pain right away.  The pain will gradually go away as the pressure is reduced.  Although factor is not a pain killer, taking factor is the way to prevent further pain.

When you have pain, first assume that the pain is due to a bleed, especially in the joints.  If you are not sure about taking factor, go ahead and take it.  It is better to take factor when you don't need it than not to take factor when you do.  If you cannot tell where the pain is coming from (for example, a joint or muscle), call your doctor or HTC.  Your doctor may want to examine you to find the source of the pain.

Remember that if you are bleeding, relieving the pain does not stop the bleeding.  Medicine and other forms of pain control are not meant to be used in place of factor, but along with it.  For instance, a cold pack might be a helpful pain reliever to be used after taking factor.  You can make your own cold pack by keeping a wet washcloth in your freezer or ice in a plastic bag.  A sack of frozen peas easily wraps around joints.

Physical therapy (PT)

Physical therapy is often used along with pain medicine.  Some physical therapy methods are exercise, water therapy, and orthopedic devices such as splints.  The physical therapist may also teach relaxation techniques or biofeedback.

TENS (transcutaneous electrical nerve stimulation) is a pain control method sometimes used in physical therapy.  A small battery-operated unit is attached to the body with wires and pads.  The unit sends out a mild current of electricity.  The brief pulses of electricity work on the nerves under the skin to reduce pain.  It works best when it is put on the skin near where the pain is felt.

Progressive relaxation and other exercises to reduce tension

When you are worried or under stress, you are less able to tolerate pain.  Fear of pain can make the pain seem much worse.  This is why an important part of pain control is learning to relax and reduce tension.  In progressive relaxation, you tense and then relax muscle groups from your head to your toes.  You can also learn deep breathing exercises to keep yourself calm.

Biofeedback

With biofeedback, you learn to be mindful of your blood pressure, heart rate, skin temperature, or muscle tension.  You then learn to gain some control over these things.  Special machines detect changes in these things and relay them to you with lights, meters, or tones.  This feedback helps you become aware of your body's state.  With practice, you can learn to control these things with your mind without using the machine.  You can learn to relax anytime and anyplace. It is not known if bleeding can be controlled with biofeedback.  Some scientists suggest that the size of small blood vessels changes when the skin temperature is lowered.  This could reduce bleeding.  We do know that biofeedback can be useful in reducing stress that worsens pain.

Acupuncture and acupressure

Acupuncture means placing tiny needles into certain points on the body to relieve pain.  Acupressure means pressing down on these places.  These methods are based on the Chinese belief that pain occurs when the flow of the body's life energy is blocked by injury or stress.  Pricking the body or applying pressure is supposed to restart the flow of energy. Some research has suggested that pain reducing substances are released by the brain as a result of acupuncture or acupressure.  These substances are called endorphins.  Neither acupuncture nor acupressure has been proven to help in hemophilia.  A member of your treatment team can help you understand what these methods might offer you.

Hypnosis

With hypnosis, you learn to concentrate on something to the point of paying little attention to what is around you or happening to you.  You learn to focus your attention on just one thing at a time.  You concentrate on or imagine that thing until you have changed your state of awareness and barely feel pain.  Hypnosis requires much practice.  The role of the hypnotist is to train you to hypnotize yourself. People do not agree on the safety of using hypnosis to reduce pain.  Pain is a vital clue that something is wrong.  It is often the first sign of a bleed.  Those who oppose hypnosis fear that people with hemophilia will neglect treating with factor if they have trained themselves not to feel pain.

Hypnosis can be useful when you are having to put the needle into the vein for an infusion.  If you picture yourself at the beach, for example, you might help yourself relax.  While thinking about the roar of the waves or the feel of the wind, you may be able to pay less attention to pain.
Perhaps the safest time to use self-hypnosis to lessen pain is after treatment.  Hypnosis can then decrease the need for pain medicine.

Pain medicines

Medicines for pain are best used as a last resort.  They are not recommended for daily pain relief but for relief of sharp, short-lived pain. Talk with your doctor before taking narcotics to relieve pain.  If your pain is bad enough to require narcotics, your doctor may want to examine you or even admit you to the hospital.  It is not uncommon for someone with hemophilia to become dependent on pain medicines. Never take aspirin or any medicine that has aspirin in it.  Aspirin can hinder blood clotting for as long as a week after you take it.

Surgery

In some cases, surgery is the only way to relieve pain.  Your doctor can help you decide if surgery such as a synovectomy or a joint replacement is right for you.  Another surgery sometimes used for pain control is arthrodesis or fusing two bones (such as small ankle bones) together.