A physiotherapy perspective

PAIN MANAGEMENT

Chair: Cameron Cramey
Understanding pain… in 20 minutes – Martina Egan-Moog
Evolving concepts in pain management – A/Prof Carolyn Arnold
Clinical application of modern pain sciences for People with Bleeding Disorders (PWBD), an ‘active approach’ – Catherine Pollard

Pain is always a topic of interest and debate in the bleeding disorder community, and it was good to see it featuring again on this year’s conference program. With up to 50% of the bleeding disorder population reporting chronic pain, this informative session was well-attended by both people with bleeding disorders and health professionals. Martina Egan-Moog gave us the rapid-fire version of the current understanding of pain – huge amounts of recent research into the area of pain is suggesting that our bodies send potential “danger signals” to our brains, and our brains “turn up” or “turn down” these messages depending on what else is happening for us. Things that can turn up these messages include stress, fatigue, or bad memories. But the messages can be turned down by positive things such as happiness, trusting relationships, and comprehending how pain works. Thus we learnt that it is really important to know how pain is interpreted by our brains, and we all need to understand that many things (happening inside and outside our bodies) will contribute to pain for each person. Most importantly, we can influence our experience of pain by acknowledging and managing things like stress and fatigue, and by looking for more positive factors that will help to turn down those danger messages! 

Carolyn Arnold then talked more specifically about pain in people with bleeding disorders, and reiterated what we have all heard before – that pain does not always mean active bleeding. We all know that synovitis (inflammation of the lining of the joint) and haemarthropathy (disease of or damage to a joint as a result of blood in the joint space) cause significant pain, and it is important to see your treatment team to help you determine what is going on for you. A team approach to controlling this pain is imperative – medications play a small role, but it is just as important to maintain a normal body weight and a healthy lifestyle, improve joint and muscle function, increase positivity and enjoyment, and decrease stress.

Catherine Pollard finished this session with a presentation about the “active approach” to managing pain in people with bleeding disorders. She presented research about exercising and training for people who experience chronic or persistent pain, and how best to approach this. It is well known that maintaining strength, flexibility, normal body weight, and activity levels is important for people with bleeding disorders to minimise bleeds, but these things are also very good for assisting with pain management. Your physiotherapist can help you devise a graduated exercise program that aims to avoid flaring up your pain, whilst still getting you the results you are after!

HEALTHY JOINTS FOR LIFE

Chair: Nicola Hamilton
Bleed, Arthritis or Something Else – Alison Morris and Abi Polus
Decision Making in Sport & Physical Activity – Not Everyone Wants to Swim! – Alison Morris

In what was a whirlwind tour of common aches and pains, injuries and conditions for the normal population, Alison Morris and Abi Polus managed to succinctly present the role of the physiotherapist in the haemophilia team. Having a diagnosis of haemophilia or another bleeding disorder obviously does not prevent any other injury or musculoskeletal condition occurring, and frequently the physiotherapist is in the best position to help work out exactly what is going on and make sure the appropriate treatment is undertaken. Alison started proceedings with a summary of common musculoskeletal conditions seen in childhood and adolescence, explaining how they appear, how they are diagnosed, and what can be done to treat them. Abi then followed on by telling us all that we have 10 good years (between about 20 and 30 years old), and then upsettingly it is all downhill in terms of musculoskeletal deterioration. An examination of common injuries and presentations seen in adulthood, complete with diagnosis and possible treatments, helped us all to better appreciate that we are ageing human bodies prone to accidents and mishaps, and this is no less true in the bleeding disorder population. A good reminder that a bleeding disorder is only one part of the puzzle when it comes to assessing joint and muscular health!

Alison Morris finished this session with a mindset-challenging presentation about decision making for participation in sport. Gone are the days of recommending swimming and other non-contact sports to everyone! Alison described the contradictions that exist in the literature around the suitability of various sports and activities for people with bleeding disorders, and the issues with trying to categorise sports as “safe” or “dangerous”, or somewhere in between. The take home message was that decisions about inclusion in a new physical activity needed to be a made from a considered and researched basis – what is the training and playing schedule like? What are the risks of the activity? Do they outweigh the benefits? What is the agreed level of acceptable risk? Can it be modified with treatment (factor), strengthening or stretching, bracing or other protective gear? These are just some of the questions, and the team at your haemophilia treatment centre can help to answer these and more as needed.

I would like to thank everyone at HFA and the many other people involved for all their work in putting together such a great conference program, and for the inclusion of the poster display, the trade areas, and the social events.