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Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie

Handlungsempfehlungen einer Expertengruppe

Pain therapy for children and adolescents with hemophilia

Recommendations by an expert panel

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Zusammenfassung

Hintergrund

Kinder und Jugendliche mit schwerer Hämophilie leiden als typische Folge der Blutungen in Muskeln und Gelenken unter akuten und chronischen Schmerzen. Ebenso spielen interventionsbezogene Schmerzen eine erhebliche Rolle. Trotz ihrer hohen Prävalenz werden die Schmerzen in dieser Patientengruppe nicht immer ausreichend thematisiert oder gezielt analgetisch behandelt.

Fragestellung

Die Handlungsempfehlungen widmen sich der Frage, wie das Schmerzmanagement für Kinder und Jugendliche mit Hämophilie verbessert werden kann und welche Besonderheiten bei ihnen in der Schmerztherapie zu beachten sind.

Material und Methode

Im Rahmen eines Expertentreffens wurde das Problem der Schmerzbehandlung bei Kindern und Jugendlichen (Alter 0 bis 18 Jahre) mit Hämophilie diskutiert. Anhand der verfügbaren Literatur und klinischen Erfahrung wurden Handlungsempfehlungen erarbeitet.

Ergebnisse

Die schmerztherapeutische Versorgung von Kindern mit Hämophilie ist häufig insuffizient, sodass die Gefahr besteht, dass akute Schmerzen zu Chronifizierung und Traumatisierung führen. Sowohl das Alter der Patienten als auch die Grunderkrankung stellen besondere Anforderungen vor allem an die medikamentöse Therapie. Konkrete Handlungsempfehlungen zur Verbesserung der Situation wurden erarbeitet.

Abstract

Background

Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated.

Objectives

This paper discusses how to improve pain management for children and adolescents (0–18 years) with hemophilia and which specific features in this population should influence decisions in pain management.

Materials and methods

An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience.

Result

Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.

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Authors and Affiliations

  1. Abteilung für Anästhesie und allg. Intensivmedizin, Landesklinikum Waldviertel Horn, Spitalgasse 8/7/9, 3580, Horn, Österreich

    W. Stromer

  2. Universitätsklinik für Anästhesiologie und Intensivmedizin, LKH-Univ.-Klinikum Graz, Graz, Österreich

    B. Messerer

  3. Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin Wien, Wien, Österreich

    R. Crevenna & B. Wagner

  4. Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich

    S. H. Hemberger & K. Thom

  5. Abteilung für Kinder- und Jugendheilkunde, Klinikum Klagenfurt, Klagenfurt, Österreich

    B. Jauk

  6. Abteilung für Kinder- und Jugendheilkunde, Kepler Universitätsklinikum Linz, Linz, Österreich

    R. Schwarz

  7. Departement für Kinder und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich

    W. Streif

  8. Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich

    K. Zwiauer

  9. Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich

    R. Likar

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  1. W. Stromer
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W. Stromer, B. Messerer, R. Crevenna, S.H. Hemberger, B. Jauk, R. Schwarz, W. Streif, K. Thom, B. Wagner, K. Zwiauer und R. Likar geben an, dass kein Interessenkonflikt besteht.

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Stromer, W., Messerer, B., Crevenna, R. et al. Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie. Schmerz 32, 404–418 (2018). https://doi.org/10.1007/s00482-018-0321-7

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