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Background and Aims Von Willebrand’s Disease is an inherited bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor. Patients with this disease present a challenge in the management of chronic pain due to the high bleeding risk. The purpose of this paper is to highlight the complexity of managing a patient with Von Willebrand and chronic lumbar sciatica.

Methods A 65-year-old male patient, presented to our Hospital’s Pain Clinic, complaining of persistent back pain and sciatica on the right for three months. His medical history revealed a prior diagnosis of Von Willebrand disease. Lumbar spine MRI revealed findings consistent with degenerative spondyloarthropathy, spinal canal stenosis at the L4-L5 vertebrae level, intervertebral disc prolapse at L3-L4, and notable narrowing of the intervertebral foramina, particularly on the right side.

Results The patient was initially treated conservatively with pregabalin, duloxetine, tramadol in a titrated dosage for 6 weeks, without significant improvement of his symptoms. After consultation with his Hematologist, he underwent preparation with Haemate (FVIII/FVW) and then an epidural injection was performed at the L4-L5 level. No bleeding complications were noted from the interventional technique. Remission of symptoms >60% and reduction in analgesic requirements was observed 1 week later.

Conclusions This case highlights the significance of carefully assessing and managing pain in patients with high bleeding risk, such as those with Von Willebrand’s Disease. The benefits and potential risks of interventional techniques must be weighed, and proper patient preparation, interdisciplinary collaboration, and compliance with safety protocols must be a top priority.