Systematic review: interventions for abdominal pain management in inflammatory bowel disease

Norton, Christine; Czuber‐Dochan, Wladyslawa; Artom, Micol; Sweeney, Louise; Hart, Ailsa

doi:10.1111/apt.14108

Cited by 85 publications

(69 citation statements)

References 64 publications

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“…A systematic review of interventions that are not diseasemodifying found limited evidence suggesting that relaxation and behavioral stress management programs may be promising in reducing IBD abdominal pain. 49…”

Section: Health Care Maintenancementioning

confidence: 99%

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

Robinson²,

et al. 2019

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Section: Health Care Maintenancementioning

confidence: 99%

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

Robinson²,

et al. 2019

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“…Alternatively, pain may be used to attract more of their doctor's attention to other symptoms. To improve the correlation of this measure, we could consider collecting additional information that may be associated with abdominal pain (i.e., disability, stress, sleep quality, fatigue) [30][31][32] because the question might be whether abdominal pain reflects a cause or a consequence of other symptoms.…”

Section: Two Previous Studies Conducted By Bennebroek Evertsz Et Almentioning

confidence: 99%

Differences in Outcomes Reported by Patients With Inflammatory Bowel Diseases vs Their Health Care Professionals

Maillard¹,

Simonson²,

Fournier³

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND AIMS Inflammatory bowel disease (IBD) scoring systems combine patientreported data with physicians' observations to determine patient outcomes, but these systems are believed to have limitations. We used real-world data from a large IBD cohort in Switzerland to compare results between patients and healthcare professionals from scoring systems for Crohn's disease (CD) and ulcerative colitis (UC). METHODS We collected data from the Swiss IBD cohort, beginning in 2006, using 2453 reports for 1385 patients (52% female, 58% with CD). During office visits, physicians asked patients about signs and symptoms and recorded their answers (health care professional-reported outcomes). On a later date, patients received a questionnaire at home (independently of the medical visit), complete it, and sent it back to the data center. Patients also completed the short form 36 and IBD quality of life (QoL) questionnaires. We calculated Cohen's kappa () statistics to assess the level of agreement in scores between patients and health care professionals (Δt between reports collected less than 2 months apart). We used Spearman correlation coefficients () to compare general well-being (GWB) and QoL scores determined by patients vs health care professionals. Our primary aim was to investigate the overall and individual level of agreement on signs and symptoms reported by health care professionals vs patients. RESULTS The best level of agreement (although moderate) was observed for number of stools last week in patients with CD (= 0.47), and nocturnal diarrhea in patients with UC (= 0.52). Agreement was low on level of abdominal pain (= 0.31 for patients with CD and = 0.37 for patients with UC) and GWB (= 0.23 for patients with CD and = 0.26 for patients with UC). Patients reported less severe abdominal pain and worse GWB (CD) or better GWB (UC) than that determined by health care professionals. Patient self-rated GWB correlated with IBD quality of life (= 0.68 for patients with CD and = 0.70 for patients with UC) and SF-36 physical scores (= 0.55 for patients with CD and = 0.60 for patients with UC); there was no correlation between health care professional-rated GWB and QoL. CONCLUSIONS In a comparison of patient vs health care provider-reported outcomes in a Swiss IBD cohort, we found that health care professionals seem to misinterpret patients' complaints. Patients self-rated GWB correlated with QoL scores, indicating that reporting GWB in a single question is possible and relevant, but can vary based on how the data are collected.

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“…Patients described this cycle as having a significant impact on emotional and physical functioning and acting as a key barrier to effective communication and management of pain. The breadth of strategies used among participants reinforces the lack of a clear consensus around optimal pain management in IBD, as supported by prior research finding a wide variety of interventions for abdominal pain in IBD (9).…”

Section: Discussionmentioning

confidence: 83%

“…Others found that medication did not reduce their pain symptoms at all: "I generally don't use paracetamol or ibuprofen for the pain, because I don't feel that they work for me" (9).…”

Section: Iii) Medication Concernsmentioning

confidence: 99%

‘It’s about willpower in the end. You’ve got to keep going’: a qualitative study exploring the experience of pain in inflammatory bowel disease

Sweeney

Moss‐Morris

Czuber‐Dochan

et al. 2019

British Journal of Pain

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Background: Pain is a widely experienced symptom of inflammatory bowel disease (IBD), which has significant psychological and functional impacts on patients. Understanding the aetiology and management of chronic pain is a poorly understood area of IBD research. This qualitative study aimed to explore the experiences of individuals with IBD and pain, the pain management strategies they use and any needs for future pain management interventions. Methods: In all, 14 individuals with IBD were purposively recruited and interviewed (face-to-face or telephone) using a topic guide. Interviews were transcribed and analysed using inductive thematic analysis. Results: Themes identified were ‘vicious cycles’, ‘findings solutions’ and ‘attitudes’. The experience and impact of pain were rarely viewed in isolation, but rather within the context of a cycle of IBD symptoms. Other ‘vicious cycles’ identified included anxiety, avoidance and inactivity, and poor understanding and communication. Pain management included short- and long-term strategies. Searching for a solution for pain had an emotional impact on individuals. There were contrasting attitudes from participants, including defeat, tolerance and acceptance. Conclusion: This study provides an understanding of the experience of pain in IBD. The interaction of pain with accompanying IBD symptoms has an emotional and physical impact on individuals, and creates a barrier to adequate assessment, understanding and treatment of pain. Patients rely on their own experiences, and a trial and error approach to apply helpful strategies. Adjuvant behavioural therapies may be beneficial for patients experiencing pain and psychological distress, and to facilitate self-management.

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Systematic review: interventions for abdominal pain management in inflammatory bowel disease

Abstract: Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD.

Cited by 85 publications

References 64 publications

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

Differences in Outcomes Reported by Patients With Inflammatory Bowel Diseases vs Their Health Care Professionals

‘It’s about willpower in the end. You’ve got to keep going’: a qualitative study exploring the experience of pain in inflammatory bowel disease

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