Nonpharmacologic treatment with cognitive-behavioral therapy (CBT) combined with physiotherapy was shown to be an effective pain management strategy for patients with severe hemophilia, according to study results published in the journal, Haemophilia.

According to the study authors, more than half of adult patients with severe hemophilia experience pain, with 15% of patients experiencing chronic pain, reducing their quality of life (QoL). Therefore, the researchers conducted a single-blind prospective controlled trial with patients with severe hemophilia who were randomly assigned to either experimental therapy with CBT (n=10) or a control group (n=9). The groups did not show significant differences (P >.05) in age or duration of pain. Patients in the experimental group received interventions over the course of 4 months, which included 1 CBT session and 3 home exercise sessions per week.

The researchers assessed self-efficacy (Chronic Pain Self-Efficacy Scale), QoL (A36 Hemophilia-QoL), emotional status (Hospital Anxiety and Depression Scale and Rosenberg’s Self-Esteem Scale), pain (Visual Analogue Scale), and kinesiophobia (Tampa Scale for Kinesiophobia) to determine whether the nonpharmacological approach was effective. These were assessed at 3 time points: week 0 prior to treatment, month 4 at the end of treatment, and month 7.

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The physiotherapy consisted of 3 home sessions per week (10 supervised and 38 self-monitored) at 1 hour per session. The CBT consisted of a total of 4 sessions at 2 hours each. The treatment program focused on teaching patients skills for optimal pain management and coping, which included increased perception of pain control and self-efficacy.

Specific goals for the CBT were to learn how psychological variables affect chronic pain; modify cognitive aspects, which negatively interfere in the experience of pain; and learn skills to regulate the patient’s level of activity, modifying behaviors that optimized any therapeutic benefit.

The experimental group showed a significant improvement over the control group in the control of symptoms and pain management on the Self-Efficacy Scale, QoL, self-esteem emotional status, pain, and kinesiophobia (P <.05).

Prior to treatment with CBT, the patients in the experimental group showed a significantly lower QoL score and a higher level of pain than the control group (P =.017). At the end of treatment at 4 months, the between-group analysis showed significant differences in pain management, self-efficacy beliefs, and self-esteem (respectively: P =.003; P =.031; P =.002), all of which were better in the experimental group. At time of follow-up 3 months after treatment, the experimental group still had higher scores than the control group in pain management and self-efficacy (P =.006 and P =.034, respectively).

“The importance of the improvement achieved lies in the association demonstrated between self-efficacy and better functioning, reductions in illness behaviour, response to treatment, disability, less depression and positive pain coping,” the authors wrote. “The non-pharmacological treatment applied, based on CBT and [physiotherapy], was shown to be effective in improving [chronic pain] self-efficacy, QoL and emotional status, as well as in reducing pain and kinesiophobia.”


García-Dasí M, Pérez-Alenda S, Carrasco JJ, et al. Effects of a non-pharmacological approach for chronic pain management in patients with haemophilia: efficacy of cognitive-behavioural therapy associated with physiotherapy. Haemophilia. Published online March 2, 2021. doi:10.1111/hae.14284