Behavioral medicine in hemophilia arthritic pain management: two case studies

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.