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Hemophilia pain

acupunctureIt is well known that persons with hemophilia have episodes of painful experiences. Pain results after an acute joint bleed, where the synovial capsule fills with blood and expands with nowhere to go. Once the bleeding is treated with factor,with time the blood in the joint is reabsorbed and the swelling and pain resolve. But we also know about those daily aches and pains, and difficulty moving the joints, especially in the morning, where the pain is there waxing and waning on a daily basis. These symptoms are most likely related to the end stage joint dysfunction resulting in daily arthritic pain. Most persons with hemophilia know how to treat a bleeding joint and minimize joint bleeding with prophylaxis. But what about the joints that have already been affected and “talk to us” daily?

What is acupuncture?

Pain management should involve a “multimodal” therapy. What does that mean? Not just treating pain with pain pills, but using other types of therapy that may work best for you.

The basis of acupuncture is that the energy called “chi” flows through and around your body along pathways called meridians. Along these meridians are target “energy points” that correlate to different parts or functions of the body. By targeting these energy points through the insertion of needles, we are able to alter the flow of energy, thus improving the health of the person.

How is acupuncture performed?

A certified acupuncturist will ask about health history and do a physical exam, using key points on your body (muscles and bones) in order to place needles in the appropriate places. Very thin needles are tapped into the skin, some deeper than others. Most often, you do not feel anything when the needles are inserted, but sometimes, you may feel a slight pressure, tingling sensation, or ache. This provides the sign that the “chi” has been accessed. After the needle has been placed, the provider may roll the needle slightly or may use heat or an electrical current on it. Most treatments can take between 15-60minutes, depending on the area of need. Acupuncture has been around for thousands of years, and used frequently for the management of arthritic pain with reported benefit.

How safe/useful is it with hemophilia?

There are both possibilities and risks of acupuncture use for persons with bleeding disorders. In theory, the needles are very small, and only enter through the first few layers of the skin, so bruising and/or bleeding should not be a problem. There have been several studies performed with acupuncture use on persons with hemophilia. In 2002, Rosted and Jorgensen reported a successful trial of acupuncture in one person after his factor level was increased to greater than 15% prior to each acupuncture treatment. After five acupuncture treatments, he reported a significant improvement in his knee pain. In 2006, Wallny studied acupuncture use on 10-12 hemophilia patients for arthritic pain and found that pain scores were improved without any bleeding episodes reported from the procedures. And most recently (reported January2012), Henry Ford Health System performed an acupuncture study with their twinning partner in India, where 9 persons with varying levels of hemophilia participated Some received factor prior to acupuncture treatments and some did not. There was no bleeding or bruising reported by any of the patients in the study. More than 50% of the patients identified a decrease in painful joints after acupuncture treatments, and a decrease in oral pain medication usage, and an improvement in quality of life.

Remember, there are multiple ways to manage pain. You have to seek what therapies will work best for you.

Is acupuncture for you? Here is what you can do:

  1. Talk to your hemophilia treatment center first to discuss what is best for you. You may be encouraged to do prophylaxis.
  2. Choose an acupuncturist who is certified by an appropriate agency. Referrals by others you trust can be helpful.
  3. Do your homework, learn about the process, and learn about the acupuncturist. You can check for certifications on the web.
  4. Success with acupuncture may require several treatments before an improvement is noted, and may require occasional repeat treatments to maintain optimal relief.
  5. Talk to the acupuncturist to know what to expect, what is a ‘normal’ response, and what may be different.
  6. Remember that pain management requires a multimodal approach. What may work for you may not work for others. You have to determine what strategies will work best for you.
  7. Keep an open mind!

By: Angela Lambing, MSN, Np-C

Angela is a nurse practitioner for the past 21 years, working as the hemophilia nurse coordinator at Henry Ford Health system for the past 11 years.  Her passions in hemophilia care are focusing on the aging issues in hemophilia and pain. She has participated in research, lectured and authored many articles related to the hemophilia pain experience.

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