Controlling Pain: Managing osteoarthritis pain in patients with von Willebrand disease
Yvonne D'Arcy MS, CRNP, CNS

July 2011 
Volume 41  Number 7
Pages 19 - 20
  PDF Version Available!

AFFECTING 1% TO 2% of the population, von Willebrand disease (VWD) is the most common inherited bleeding disorder. VWD is generally milder than hemophilia and affects both genders, whereas hemophilia affects mostly males. The prevalence of this common cause of bleeding disorders varies because different case definitions are used.1,2Because these patients have an increased bleeding risk, managing their chronic pain can be challenging. Many analgesics, such as nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), can increase bleeding risk, and some pain-control techniques, such as epidural injections, are usually contraindicated in patients with VWD.3This article discusses safe, effective pain management options for these patients. Using a multimodal approach will provide a better level of pain relief than relying on medications alone. For more about this condition, see Factors at play in VWD.Osteoarthritis (OA), a common source of chronic pain, has a well-defined inflammatory component.4,5 Nonselective NSAIDs such as ibuprofen or naproxen, or celecoxib, the selective COX-2 inhibitor, are commonly used to relieve this type of pain.4When patients have both OA and VWD (or another condition that increases bleeding risk), use NSAIDs cautiously because of the effect these drugs have on platelet aggregation. In patients taking NSAIDs, blood won't clot as easily as in patients who aren't using NSAIDs.Acetaminophen is usually considered safe for patients with VWD because it doesn't interfere with platelet function.For long-term pain relief, some new options for managing OA pain are available for patients with VWD; for example, targeted topical NSAIDs. Because they're applied topically, patients with VWD should be able to use these prescription-strength compounds with their healthcare provider's approval. These topical agents provide local pain relief with little systemic uptake. The adverse reactions to oral NSAIDs, such as gastrointestinal (GI), cardiovascular, and renovascular

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