Gaining insight into the complexity of pain in people with haemophilia from a biopsychosocial perspective
Joint pain is the hallmark of haemophilia, therefore it seems clinically rather a musculoskeletal (MSK) than a bleeding disorder. Unlike other chronic MSK disorders, pain assessment in people with haemophilia (PwH) remains mainly focused on the structural evaluation of their joints. While there is currently insufficient knowledge about the (patho)physiology, underlying pain mechanisms and biopsychosocial context of pain in PwH. Presumably, this explains the fact that, to date, only a limited number of haemophilia-specific pain management options exist, that PwH suffer from chronic pain and that they report reduced health-related quality of life (HR-QoL). Therefore, this PhD thesis aimed to comprehensively explore pain in PwH from a biopsychosocial perspective, dividing the research into three parts: The first part described a systematic literature review to identify the coping strategies used by PwH to manage their pain. It served as an encouragement for healthcare professionals to promote effective cognitive-emotional behavioral pain coping strategies, as inadequate coping strategies can lead to negative health outcomes. The second part involved a longitudinal pain study in people with (Sub)Acute Low Back Pain ((S)ALBP), a related chronic MSK condition. The study aimed to explore the associations between psychophysical and psychological factors at baseline and disability after a 3-month follow-up. While no significant associations were found, the study suggests that unhelpful psychological factors like kinesiophobia can negatively impact disability and contribute to chronicity. The third part focused on a longitudinal pain study in PwH. This section included three chapters: -Chapter 3 investigated pain sensitivity, modulation, and pain-related psychological factors in PwH and healthy volunteers, revealing differences, particularly in PwH with widespread pain. -Chapter 4 applied the International Association for the Study of Pain (IASP) clinical criteria to classify PwH and identified a small group with suspected predominant nociplastic pain. -Chapter 5 reported results from a prospective study in PwH linking baseline pain-related and psychological factors to pain interference with daily functioning at 12-month follow-up. The findings from this PhD thesis emphasize the multidimensional and biopsychosocial context of pain in haemophilia and suggest the presence of different pain phenotypes and psychological profiles within PwH. The thesis concludes by suggesting future research directions, including expanding comparisons with different populations, conducting experimental studies to develop tailored pain management strategies, and ultimately improving PwH’s HR-QoL.
Antwerp : University of Antwerp & Catholic University of Louvain , 2023
208 p.
Supervisor: Roussel, Nathalie [Supervisor]
Supervisor: Meeus, Mira [Supervisor]
Supervisor: Hermans, Cédric [Supervisor]
Supervisor: Lobet, Sébastien [Supervisor]
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Creation 28.09.2023
Last edited 15.10.2023
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