Psychology and Physiotherapy Approach of Chronic Pain in Patients With Hemophilia

The purpose of this study is to improve the perception of the experience of chronic pain, as well as functionality and quality of life in hemophilic patients with chronic pain

Secondary objectives are:

• to change the perception that the patient has of their pain, to improve the coping strategies and to increase the perception of self-efficacy of patients in pain management.
• to increase the resources that allow a better self-regulatory of emotional, cognitive and competential of the pain experience, reverting in the emotional state of patients, particularly in levels of anxiety and depression.
• to improve functional capacity and musculoskeletal status.
• to improve quality of life.
• to determine whether changes / improvements are maintained over time 3 months after finishing the program

• Other: Psychology and Physiotherapy group

  Psychological program: 4 sessions,2 hours each,4 months

  • Psychoeducation.Influence of psychological factors on chronic pain: modulators of pain experience. Biopsychosocial model of pain.
  • Training techniques of psychological management of pain:Diaphragmatic Breathing and Progressive Muscle Relaxation to control vicious circle pain-tension-pain.
  • Kinesiophobia. Rational regulation of the activity level:Cognitive therapy (management of irrational believes about pain) and Organisation of time and reinforcement activities.

  Physiotherapy program:3 sessions per week,1 hour per session,4 months:

  • Aerobic exercise:walking, cycling
  • Warm-up: active ROM exercises of inferior and superior extremities (ISE)
  • Progressive resistance training with elastic bands of ISE
  • Stretching of ISE
• Other: Placebo comparator: control group
  Control group Normal daily activities Usual daily activities

• Experimental: Psychology and Physiotherapy group
  The psychological program consists of 4 sessions (2 hours each) comprising psychoeducation, training techniques of psychological management of pain and kinesiophobia resources The physiotherapy program consists of 3 domiciliary sessions per week, including physical exercise and stretching
  Intervention: Other: Psychology and Physiotherapy group
• Placebo Comparator: Placebo Comparator: Control group
  Usual daily activities
  Intervention: Other: Placebo comparator: control group

Inclusion Criteria:

• Diagnosis of haemophilia A or B.
• Age between 18 and 60 years.
• Informed consent signed.
• Signs of arthropathy according to clinical criteria (score Gilbert) and / or radiological criteria (score Pettersson) in at least one of the six joints most commonly affected (ankles, knees or elbows)
• Chronic pain (CP) defined as persistent pain lasting at least six months and resistant to conventional medical therapy. It differs from the acute pain not only in its longer duration, but also sometimes persists even after the cause that produced it has disappeared.
• Absence of active coping strategies, understanding the concept of coping as those cognitive and behavioral efforts made by the individual in order to manage internal and external demands generated by their chronic pain condition and that involve a challenge to their potential individual resources.

Exclusion Criteria:

• Presence of inhibitor to FVIII or FIX.
• Another haemostatic defect.
• Patients with severe cognitive deficits with which it is not possible a cognitive psychological intervention.
• The inability to attend physiotherapy sessions for 12 consecutive weeks (7 supervised and 31 self-monitored)
• Surgical procedures performed 6 weeks prior or during the intervention protocol.
• Not acceptance or withdrawal of informed consent