Pain in irritable bowel syndrome: Does anything really help?

Abstract

Pain relief remains a significant challenge in the management of irritable bowel syndrome (IBS): "Does anything really help relieve the pain in patients with IBS?".Interventions aimed at pain relief in patients with IBS include diet, probiotics or antibiotics, antidepressants, antispasmodics, and drugs targeting specific gastrointestinal receptors such as opioid or histamine receptors. In the systematic review and metaanalysis published in this journal, Lambarth et al. examined the literature on the role of oral and parenteral anti-neuropathic agents in the management of pain in patients with IBS. This review article appraises their assessment of the efficacy of the antineuropathic agents amitriptyline, pregabalin, gabapentin, and duloxetine in the relief of abdominal pain or discomfort, and impact on overall IBS severity and quality of life. This commentary provides an update of current evidence on the efficacy of the dietary and pharmacological treatments that are available or in development, as well psychological and cognitive behavioral therapy for pain in IBS. Advances in recent years augur well for efficacious treatments that may expand the therapeutic arsenal for pain in IBS.

Substance-based medical devices made of natural substances: An opportunity for therapeutic innovation

“…1-In improving the benefit/risk ratio of current therapeutics, with a aim of minimal impact on the physiology of the whole body, especially in the long term, and on the environment. 2-In managing the complexity of new diseases and treatments: degenerative, metabolic and functional diseases, as well as multifactorial syndromes, occur at an increasingly higher frequency as the population ages (Van den Berg et al, 2006, Kelishadi 2007, Cockerham et al, 2017, GBD 2015Obesity Collaborators 2017, DeBoer 2019, Cobiac and Scarborough 2021, Dellafiore et al, 2022, Guarino et al, 2022, Nguyen et al, 2022) and often have unsatisfactory or inadequate treatments (Black and Ford, 2021;Strisciuglio et al, 2021;Bousaba et al, 2022;Negi et al, 2022;Singh et al, 2022).…”

Efficacy and safety of olorinab, a full agonist of the cannabinoid receptor 2, for the treatment of abdominal pain in patients with irritable bowel syndrome: Results from a phase 2b randomized placebo‐controlled trial (CAPTIVATE)

“…29 However, many patients with IBS have failed to meet this criterion for improvement in abdominal pain in pivotal randomized controlled trials of new therapeutic agents targeting IBS-C and IBS-D. [30][31][32] Effective, long-lasting, and well-tolerated treatment of abdominal pain is therefore an unmet need in IBS. 13,14 Olorinab may offer a well-tolerated, novel approach to abdominal pain management in IBS.…”

“…[9][10][11] Current pharmacological management of IBS has demonstrable symptom impact on bowel alteration, but is often less effective for controlling abdominal pain. 12,13 Antispasmodic agents are frequently prescribed off-label in the United States as first-line pain management in IBS, although most lack robust clinical data to validate their efficacy in ameliorating abdominal pain. 13,14 Other pharmacologic treatments for the abdominal pain of IBS include neuromodulators, opioid receptor modulators, GABAergic agents, probiotics, antibiotics, and secretagogues; however, side effects can be problematic with some therapies, and in many patients pain relief remains suboptimal.…”

“…12,13 Antispasmodic agents are frequently prescribed off-label in the United States as first-line pain management in IBS, although most lack robust clinical data to validate their efficacy in ameliorating abdominal pain. 13,14 Other pharmacologic treatments for the abdominal pain of IBS include neuromodulators, opioid receptor modulators, GABAergic agents, probiotics, antibiotics, and secretagogues; however, side effects can be problematic with some therapies, and in many patients pain relief remains suboptimal. 2,[13][14][15] Thus, there remains an unmet need for well-tolerated and effective pharmacologic options to manage abdominal pain in IBS.…”

“…13,14 Other pharmacologic treatments for the abdominal pain of IBS include neuromodulators, opioid receptor modulators, GABAergic agents, probiotics, antibiotics, and secretagogues; however, side effects can be problematic with some therapies, and in many patients pain relief remains suboptimal. 2,[13][14][15] Thus, there remains an unmet need for well-tolerated and effective pharmacologic options to manage abdominal pain in IBS. 14 The cannabinoid receptor 2 (CB 2 ) is a G-protein coupled receptor subtype that is part of the endocannabinoid system and is expressed on human enteric nerves and on colonic epithelium, as well as on macrophages and plasma cells in the lamina propria.…”