Managing pain in inflammatory bowel disease

Abstract

Pain is a common complaint in inflammatory bowel disease, and it has significant consequences for patients' quality of life. A thorough evaluation to determine the source of patients' pain should include clinical, laboratory, radiologic, and endoscopic assessments as indicated. Differentiating among active inflammation, secondary complications, and functional pain can be complicated. Even when all active disease is adequately treated, clinicians are often left with the difficulty of managing chronic pain. This paper will review the benefits and limitations of several commonly used treatments and promising future therapies. A suggested treatment algorithm will provide some guidance in this challenging area of inflammatory bowel disease management.

Keywords: Inflammatory bowel disease; irritable bowel syndrome; management; pain.

Figure 1

Mechanisms of pain in inflammatory bowel disease. Nociceptive stimuli can be detected by either somatic primary afferents (red) or visceral primary afferents (blue). ACC

anterior cingulate cortex

Amyg

amygdala

DRG

dorsal root ganglia

PAG

periaqueductal gray matter

RVM

rostroventromedial medulla

SS

somatosensory cortex

Thal

Thalamus

Figure 2

Treatment algorithm for pain in inflammatory bowel disease (IBD). The dashed arrows indicate that the drugs should be used with caution. NSAIDs

nonsteroidal anti-inflammatory drugs