Pain Management in Patients with Inflammatory Bowel Disease

Abstract

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) that negatively affects quality of life and can lead to increased health-seeking behavior. Although abdominal pain has been traditionally attributed to inflammation, there is growing literature demonstrating the existence of functional abdominal pain in patients with IBD, of which there are a variety of potential causes. Thus, when approaching a patient with IBD who has abdominal pain, in addition to IBD-related complications (e.g., inflammation/stricture), it is important to screen for related contributors, including peripheral factors (visceral hypersensitivity, bacterial overgrowth, and bowel dysmotility) and centrally mediated neurobiological and psychosocial underpinnings. These central factors include psychological symptoms/diagnoses, sleep disturbance, and stress. Opioid-induced hyperalgesia (e.g., narcotic bowel syndrome) is also growing in recognition as a potential central source of abdominal pain. This review draws from clinical studies and animal models of colitis and abdominal pain to consider how knowledge of these potential etiologies can be used to individualize treatment of abdominal pain in patients with IBD, including consideration of potential novel treatment modalities for the future. Accurate assessment of the source(s) of pain in patients with IBD can help guide appropriate diagnostic workup and use of disease-modifying therapy.

The Pain Experience of Patients Hospitalized With Inflammatory Bowel Disease

“…Often, pain management strategies used generally for patients with chronic pain show no clear evidence that those strategies are useful to treat pain in patients with IBD ( Barlow, Cooke, Mulligan, Beck, & Newman, 2010 ). Researchers have been looking at the complex modalities of IBD, types of pain, and treatment options, but there are many barriers to effective pain management, including factors specific to those with Crohn disease and ulcerative colitis that contribute to patient suffering ( Srinath, Young, & Szigethy, 2014 ).…”

Differences in regional homogeneity between patients with Crohn's disease with and without abdominal pain revealed by resting-state functional magnetic resonance imaging

“…Treatment options for this particular symptom are limited due to its obscure mechanism [40]. The potential mechanisms include inflammation, visceral hypersensitivity, brain-gut axis dysfunction and psychological abnormalities, among which dysfunction of brain-gut interactions is considered to be vital [11, 32].…”

Mind–Body Interventions for Pediatric Inflammatory Bowel Disease

“…Symptoms of pain and discomfort may persist even after inflammation is adequately controlled due to visceral hyperalgesia, somatic-parietal abdominal pain, referred pain, strictures or adhesions, small intestinal bacterial overgrowth (SIBO), dysmotility, and central sensitization [20]. Factors that may increase central sensitization include disordered sleep, social stressors, and the presence of anxiety or depression [20]. IBD and IBS have overlapping and interacting mechanisms of illness.…”