Pain and inflammatory bowel disease

Abstract

Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn's disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations. Keywords sensitization; hyperalgesia; inflammatory bowel disease PREVALENCE AND IMPACT OF PAIN ON IBDPain is an important manifestation of inflammation, as inflammatory cytokines and mediators sensitize primary afferent neurons. It should thus not be surprising that pain is 1 of the presenting symptoms in about 50%-70% of patients experiencing the initial onset or exacerbations of inflammatory bowel disease (IBD).1 , 2 However, ongoing and/or severe inflammation does not suffice to explain pain in IBD patients, as about 20% of patients in clinical and even endoscopic remission continue experiencing significant symptoms. Up to one-sixth of IBD patients are chronically treated with opioids. 3 -5 Physicians and patients typically think of pain as an alarm symptom that is triggered by high intensity and potentially noxious stimuli. This physiologic role of pain as an indicator of impending injury

Qualidade de vida de pacientes com doença de Crohn

“…La diferencia puede estar relacionada con otros diversos aspectos (18) . Por otro lado, evidencias confirman que los pacientes que tienen duración de la enfermedad más reciente tienden a ser más ansiosos, lo que influye considerablemente en la CV, aunque no fue demostrada todavía tal significancia de que cuanto más larga la duración mejor CV (28) .…”

Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research

“…2 Although it is often a disabling feature of chronic conditions such as arthritis, 3 diabetes, 4 cancer, 5 cardiovascular disease, 6 HIV, 7 inflammatory bowel disease, 8 and autoimmune diseases, 9 chronic pain is now recognized as a disease in its own right. 10 Chronic pain affects more than six million Canadians of all ages and is most prevalent among women, Indigenous peoples, and older adults.…”

Mast cells and the cyclooxygenase pathway mediate colonic afferent nerve sensitization in a murine colitis model

“…These symptoms are initiated by the release of an array of inflammatory mediators with subsequent sensitization of visceral afferent nerves (1). Despite this common knowledge, our understanding of mechanisms that may contribute to this sensitization and subsequent perception of pain during intestinal inflammation is limited.…”

“…Xue B, 1,2 Müller MH, 2,3 Li J, 1 Pesch T, 4 Kasparek MS, 2 Sibaev A, 2 Hausmann M, 4 Rogler G, 4 Kreis ME.…”