Pain Characteristics in Patients with Inflammatory Bowel Disease: A Monocentric Cross-Sectional Study

Abstract

Background and aims The abdominal pain common in Inflammatory Bowel Disease (IBD) patients is traditionally associated with inflammation but may persist during clinical remission. Central sensitisation (CS) has never been explored in these patients. This study aimed to determine the epidemiology of pain in IBD patients and to specify pain characteristics with special attention to CS. Methods This cross-sectional study included 200 patients; 67% had Crohn’s disease (CD). Pain was assessed using the McGill questionnaire, the Douleur Neuropathique 4 (DN4) questionnaire, and by clinical examination. Its impacts on the quality of life, depression and anxiety were also assessed. Results Three-quarters of IBD patients complained of pain, including intermittent pain attacks, 62% reported abdominal pain, and 17.5% had CS. Prevalence of pain (83.6% vs. 59.1%; p < 0.001) and abdominal pain (68.7% vs. 48.5%; p = 0.006) was higher in CD patients than in ulcerative colitis (UC) patients. Multivariate analysis confirmed that age (p = 0.02), sex (female) (p = 0.004), and CD (p = 0.005) were independent risk factors for pain. Pain intensity was greater in case of CS (6 [5 - 3] vs. 3 [1.5 - 5], p < 0.003) which significantly impaired quality of life (p < 0.003) compared with pain without CS. Conclusions The prevalence of pain was high in IBD patients (≈75%) and higher in Crohn's patients. Significant impacts on quality of life were confirmed. More than 25% of patients with abdominal pain described CS responsible for more severe pain and worsened quality of life.

Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms

“…Moreover, alexithymia, and clinical psychological symptoms may compromise patient’s compliance and adherence, leading to frequent relapses and to a worse clinical course of IBD (Viola et al ., 2023 ). Even though IBD affects both genders equally, our study confirmed women with IBD showed higher prevalence of anxiety and depressive symptoms, together with lower HR-QoL (Hardy et al ., 2022 ). Age was also associated with higher anxiety and alexithymia, suggesting a possible explanatory role of chronic fatigue, levels of stress, and persistent abdominal pain even in the remission phase (Villoria et al ., 2019).…”

Acute Administration of Ojeok-san Ameliorates Pain-like Behaviors in Pre-Clinical Models of Inflammatory Bowel Diseases

“…Gastrointestinal pain and fatigue are the most reported concerns of patients with IBD [ 5 , 61 ]. Commonly prescribed drugs for IBD focus on decreasing excess inflammation without effectively managing patients’ pain [ 7 , 8 , 9 ].…”

“…Diarrhea, weight loss, and rectal bleeding are common side effects associated with extensive and long-lasting inflammation. A total of 70% of patients suffering from IBD will report abdominal and rectal pain [ 3 , 4 , 5 ]. This visceral pain (VP) will often dissipate as the patient recovers.…”