Chronic pain in patients with inflammatory bowel disease

Bakshi, Nikul; Hart, Ailsa; Lee, Michael C.; Williams, Amanda C de C; Lackner, Jeffrey M.; Norton, Christine; Croft, Peter

doi:10.1097/j.pain.0000000000002304

Cited by 27 publications

(13 citation statements)

References 101 publications

(157 reference statements)

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“…However, chronic visceral pain can also arise from a nociplastic origin, a form of pain that can be present without objective stimuli and arises from dysfunctional pain processing in the CNS and altered interaction between the peripheral/enteric and CNS. 80 In case of visceral hypersensitivity, an increased sensitivity to stimuli in the internal organs is present. In patients with IBD, it may be induced by previous or ongoing low-grade inflammation via the upregulation of transient potential vanilloid receptor 1 (TRPV1).…”

Section: Visceral Hypersensitivitymentioning

confidence: 99%

Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission

Aliu,

Bosch,

Keszthelyi

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundPersistent gastrointestinal symptoms are prevalent in adult patients with inflammatory bowel disease (IBD), even when endoscopic remission is reached. These symptoms can have profound negative effects on the quality of life of affected patients and can be difficult to treat. They may be caused by IBD‐related complications or comorbid disorders, but they can also be explained by irritable bowel syndrome (IBS)‐like symptoms.AimsTo provide a practical step‐by‐step guide to diagnose and treat persistent gastrointestinal symptoms in patients with IBD in remission via a personalised approach.MethodsWe scrutinised relevant literature on causes, diagnostics and treatment of persistent gastrointestinal symptoms (abdominal pain or discomfort, bloating, abdominal distension, diarrhoea, constipation and faecal incontinence) in patients with IBD in remission.ResultsA graphical practical guide for several steps in diagnosing, identifying potential triggers and adequate treatment of persistent gastrointestinal symptoms in IBD in remission is provided based on supporting literature. The first part of this review focuses on the diagnostic and treatment approaches for potential IBD‐related complications and comorbidities. The second part describes the approach to IBS‐like symptoms in IBD in remission.ConclusionsPersistent gastrointestinal symptoms in IBD in remission can be traced back to potential pathophysiological mechanisms in individual patients and can be treated adequately. For both IBD‐related complications and comorbidities and IBS‐like symptoms in IBD in remission, pharmacological, dietary, lifestyle or psychological treatments can be effective. A systematic and personalised approach is required to reduce the burden for patients, healthcare systems, and society.

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Section: Visceral Hypersensitivitymentioning

confidence: 99%

Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission

Aliu,

Bosch,

Keszthelyi

et al. 2024

Aliment Pharmacol Ther

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“…The mechanism of the persistence of pain despite a lack of objective inflammation is unclear and can be controversially explained as irritable bowel syndrome [ 29 ]. Other complications may arise during IBD management and should be investigated in the absence of inflammation: adherences, small intestinal bacterial overgrowth, and colorectal cancer [ 7 ].…”

Section: Mechanisms Of Chronic Abdominal Painmentioning

confidence: 99%

“…Alternative drugs to opioids should be encouraged [ 6 , 7 , 65 , 66 ]. Antidepressant and anxiolytic medications may be an interesting option for abdominal pain especially if there are coexisting mood disorders.…”

Section: Pain Managementmentioning

confidence: 99%

“…Notably, the consequent association between pain and depression, stress, or anxiety suggests that the optimal management of these mood disorders may improve pain levels and QOL. In the IBD field, psychological interventions, particularly cognitive behavioral therapy (CBT), have been found as valid approaches for functional gastrointestinal symptoms and pain [ 7 , 66 ]. Coping skill training, another psychological and educational intervention, developed to increase individuals’ ability to manage uncomfortable or anxiety-provoking situations, improved somatic symptoms in IBD adolescents but did not significantly affect pain [ 84 ].…”

Section: Pain Managementmentioning

confidence: 99%

“…Pain can result from ongoing inflammation or coexistent functional disorders like irritable bowel syndrome (IBS) [ 5 ]. Literature data demonstrated that in IBD, inflammation sensitizes primary afferent neurons leading to chronic abdominal pain [ 6 , 7 ]. Moreover, alterations of the brain–gut interactions can modulate the perception of pain, contributing to its occurrence [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Abdominal Pain in Inflammatory Bowel Diseases: A Clinical Challenge

Wils

Caron

D’Amico

et al. 2022

JCM

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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.

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Sleep quality is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain

Barnes,

Bryant,

Mukherjee

et al. 2024

JGH Open

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Background and AimQuality of life is reduced in people with inflammatory bowel disease (IBD) and poor sleep is prevalent in people with IBD. This study aimed to investigate the influence of sleep on quality of life (QoL) in people with inflammatory bowel disease.MethodsAn online questionnaire was administered through three tertiary IBD centers, social media, and through Crohn's Colitis Australia. The questionnaire included the EQ‐5D‐5L measures of health‐related QoL, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index (PSQI), and validated IBD activity and mental health scores.ResultsThere were 553 responses included with a diagnosis of Crohn's disease (62.2%), with over half on biologic therapy (53.1%). Poor sleep and clinically significant insomnia were associated with lower QoL (EQ‐5D‐5L scores: EQVAS, utility score, P < 0.001 for all). Sleep quality scores correlated with the EQ‐5D‐5L domains of “pain” (ρ 0.35, P < 0.001), “usual activities” (ρ 0.32, P < 0.001), and “depression‐anxiety” (ρ 0.37, P < 0.001). After adjusting for demographic variables, IBD activity, and depression and anxiety via multivariate regression, the “pain” domain continued to be associated with PSQI components “sleep quality” (P < 0.001), “sleep disturbance” (P < 0.001), and “sleep duration” (P < 0.001). Clinically significant insomnia was associated with a reduction in QoL (EQVAS, utility score) independent of IBD activity (P < 0.001) and of a similar magnitude to that seen with IBD activity.ConclusionHealth‐related QoL in IBD is influenced by aspects of sleep quality irrespective of IBD activity and mental health conditions. The presence of insomnia is associated with a reduction in health‐related QoL. Consideration should be given to sleep targeting interventional studies in an IBD population.

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Chronic pain in patients with inflammatory bowel disease

Cited by 27 publications

References 101 publications

Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission

Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission

Abdominal Pain in Inflammatory Bowel Diseases: A Clinical Challenge

Sleep quality is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain

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