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. 2012 Sep;5(5):339-57.
doi: 10.1177/1756283X12446158.

Pain management in patients with inflammatory bowel disease: insights for the clinician

Arvind Iyengar Srinath  1 , Chelsea Walter, Melissa C Newara, Eva M Szigethy
Affiliations

Pain management in patients with inflammatory bowel disease: insights for the clinician

Arvind Iyengar Srinath et al. Therap Adv Gastroenterol. 2012 Sep.

Abstract

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population.

Keywords: Crohn’s Disease; abdominal pain; inflammatory bowel disease (IBD); irritable bowel syndrome (IBS); narcotic bowel syndrome; small intestinal bacterial overgrowth; ulcerative colitis; visceral hypersensitivity.

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Conflict of interest statement

Conflict of interest statement: The authors declare no conflicts of interest in preparing this article.

Figures

Figure 1.
Figure 1.
The multidimensional bidirectional relationship between luminal, neurobiological, psychological, and psychosocial factors and abdominal pain in inflammatory bowel disease (IBD). ACTH, adrenocorticotropic hormone; NE, norepinephrine. (Reproduced from Eisenbruch [2011] with permission.)
Figure 2.
Figure 2.
Overview of treatment options for abdominal pain in inflammatory bowel disease (IBD). 5-ASA, 5-aminosalicylic acid; IBS, irritable bowel syndrome; TNF, tumor necrosis factor. (Courtesy of Dr. Douglas Drossman.)
Figure 3.
Figure 3.
Clinical algorithm for abdominal pain management in inflammatory bowel disease (IBD). CBT, cognitive behavioral therapy.
See this image and copyright information in PMC

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