Abdominal Pain in Inflammatory Bowel Diseases: A Clinical Challenge

Abstract

Up to 60% of inflammatory bowel disease (IBD) patients experience abdominal pain in their lifetime regardless of disease activity. Pain negatively affects different areas of daily life and particularly impacts the quality of life of IBD patients. This review provides a comprehensive overview of the multifactorial etiology implicated in the chronic abdominal pain of IBD patients including peripheral sensitization by inflammation, coexistent irritable bowel syndrome, visceral hypersensitivity, alteration of the brain–gut axis, and the multiple factors contributing to pain persistence. Despite the optimal management of intestinal inflammation, chronic abdominal pain can persist, and pharmacological and non-pharmacological approaches are necessary. Integrating psychological support in care models in IBD could decrease disease burden and health care costs. Consequently, a multidisciplinary approach similar to that used for other chronic pain conditions should be recommended.

Unklare Bauchschmerzen: Wann ist es eine Divertikelkrankheit und wann nicht?

“…Die Plastizität der peripheren und zentralen Schmerzmechanismen ist für die individuellen und unterschiedlichen Schmerzbedingungen mit erniedrigten Schmerzschwellen, einer veränderten zentralen Reizverarbeitung bzw. psychosomatischen Einflüssen verantwortlich [3,4,5,6,7]. Zusätzlich kann das enterische Nervensystem ("Bauchhirn") bis zu einem gewissen Grad lernen [8].…”

Older Adult-Onset of Inflammatory Bowel Diseases Is Associated With Higher Utilization of Analgesics: A Nationwide Cohort Study

“…Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the gastrointestinal tract that often cause pain (1)(2)(3)(4). Pain may be related to bowel inflammation, extraintestinal manifestations, or gastrointestinal surgery, among other etiologies.…”

“…Pain may be related to bowel inflammation, extraintestinal manifestations, or gastrointestinal surgery, among other etiologies. Various classes of analgesics are used, including strong opioids (e.g., morphine, oxycodone, hydromorphone), weak or synthetic opioids (e.g., tramadol, codeine), nonsteroidal antiinflammatory drugs (NSAID), and paracetamol (i.e., acetaminophen) (4,5). The clinical management of pain with analgesics requires careful consideration because of adverse effects such as addiction, gastrointestinal toxicities, severe infection, and mortality (4).…”

“…Various classes of analgesics are used, including strong opioids (e.g., morphine, oxycodone, hydromorphone), weak or synthetic opioids (e.g., tramadol, codeine), nonsteroidal antiinflammatory drugs (NSAID), and paracetamol (i.e., acetaminophen) (4,5). The clinical management of pain with analgesics requires careful consideration because of adverse effects such as addiction, gastrointestinal toxicities, severe infection, and mortality (4). In addition, the use of analgesics may inappropriately mask the severity of IBD and delay necessary medical care, which can lead to complications (6).…”

Distinct Alterations in Central Pain Processing of Visceral and Somatic Pain in Quiescent Ulcerative Colitis Compared to Irritable Bowel Syndrome and Health

“… 3 Effective treatment of abdominal pain remains a major challenge. 4 In fact, one in four patients reports their IBD-related pain to be untreated, 1 with detrimental effects on health-related quality of life. 5 , 6 Despite its clinical relevance, research on the mechanisms of pain perception and underlying neural circuits in IBD remains limited, especially in ulcerative colitis [UC].…”