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Pain Management

About 100 million Americans suffer from chronic pain (also called persistent pain) resulting from a variety of illnesses and conditions. Pain can be difficult to manage because each person feels and responds to pain in his or her own unique way. In other words, pain is a subjective experience. The way a person experiences pain can be related to several factors.

  • Biological Factors
    • The extent of illness or injury
    • The presence of other illnesses or conditions
    • Genetics—the heredity traits and variations of the human organism
  • Psychological Factors
    • Anxiety, fear, guilt, anger, depression
    • Thinking the pain is due to something worse than it actually is
    • Feeling helpless to manage pain
  • Social Factors
    • How others close to you react to the pain
    • The work environment or demands
    • Access to medical care
    • Cultural beliefs

The National Institutes of Health (NIH) and other organizations that set health care recommendations have begun to recognize the need for improved research, education, and treatment guidelines when it comes to pain. Ongoing pain can result in anxiety, depression, and anger—and can make managing your bleeding disorder seem to be an even bigger challenge.

Understanding Types of Pain

Pain is very common in people with bleeding disorders. On average, people with bleeding disorders rank their average level of daily pain as 5 on a scale of 1 to 10. Unfortunately, the pain is often not well controlled. While pain is distressing and can impact your emotional and physical health, pain can be managed successfully with the right approach (or combination of approaches).

There are two types of pain: acute pain and chronic pain. Being able to identify which type of pain you are experiencing is the first step in figuring out what you can do to help alleviate it.

  • Acute pain. This type of pain is short-term (although this means it can last for hours or days) and may be severe. When it is associated with bleeding episodes, it should be treated promptly.
  • Chronic pain (also called persistent pain). This type of pain lasts for months or longer and is characterized by ongoing discomfort. It is often a result of prior damage to the joints and other parts of the body, perhaps from earlier bleeding episodes.

Treating Pain

The first step to treating your pain is determining if you're experiencing acute or chronic pain. If you suspect a bleed into muscle or a joint (a cause of acute pain), an infusion of factor may be appropriate. But note that more than one third of people with bleeding disorders have been found to mistakenly treat chronic pain with an infusion of factor. When in doubt, you should infuse. But if your pain does not improve after an infusion of factor, it may be due to a cause other than a bleed.

See the sections below to learn about the different types of treatment to control pain.


After you've determined whether or not to infuse clotting factor, you should treat acute pain by the acronym R.I.C.E.: rest, ice, compression, and elevation.

  • Rest. Avoid using the affected body part for 24 to 48 hours. If a bleed is suspected, you may also splint the joint to limit movement and further bleeding.
  • Ice. Apply ice to the affected body part. Ice constricts blood vessels and works to reduce pain and swelling.
  • Compression. Apply elastic bandages to the affected body part. Compression works to reduce pain and prevent further bleeding.
  • Elevation. Keep the affected body part raised, or elevated. Elevation reduces swelling.
For a print out of these instructions, go to R.I.C.E.

Over-The-Counter Pain Relievers

You may also consider using over-the-counter (OTC) or prescription medication to reduce acute pain. Because many pain medications can be harmful to people with bleeding disorders, you should be careful about which ones you use. Nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, aspirin, ibuprofen, naproxen) can interfere with clotting by affecting platelet function. Some individuals with hemophilia can take ibuprofen or naproxen without increased bleeding, but this should be done under the supervision of their healthcare providers. Some people do take celecoxib, which is a type of prescription NSAID called a COX-2 inhibitor, that does not affect platelet function. There is some concern with the use of celecoxib because similar drugs have been associated with an increased risk of heart attacks. These factors should be taken into account before deciding which medication is best for your pain management needs.

Acetaminophen is an over-the-counter option for pain management that does not interfere with clotting. However, because prolonged use of acetaminophen can harm the liver, you should limit your dose to no more than 4000 milligrams per day if you are 60 years old or younger or 3000 milligrams per day if you are over age 60. Individuals infected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) should ask their healthcare provider before using acetaminophen.

Prescription Pain Medicines

Prescription pain medications are available to help with short-term, and sometimes chronic (called persistent), pain relief. These include oxycodone, morphine, methadone, and codeine. These drugs are effective for many people but can be addictive. They should be used as directed and under medical supervision.

Other Methods for Managing Pain

Chronic pain is also often treated with over-the-counter or prescription medication, but there are other strategies that can be employed as well, such as joint replacement, fusion, or reconstruction. Chronic pain may also respond to physical therapy and exercise.

In addition to helping keep your joints and muscles strong and healthy, physical therapy can help decrease pain. Your physical therapist can design a program tailored to your specific needs and current health status.

Another potential pain management technique for people with bleeding disorders is transcutaneous electrical nerve stimulation (TENS). During TENS, low-voltage electrical current is passed through the skin to stimulate nerves in the affected area. This stimulation, which is not painful, is thought to mask pain signals.

To learn about other, less traditional ways of managing pain, go to Complementary and Alternative Medicine.