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

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.

Pediatric Ulcerative Colitis from Prevalence to Outcome

“…The clinical presentation of UC patients in this study was similar to other studies were bloody diarrhea and abdominal pain are the most common presentations [2,9,11,14,16,17]. For instance, Al-Qabandi, et al [14] reported bloody diarrhea in 94% and abdominal pain in 78% of UC patients.…”

“…For instance, Al-Qabandi, et al [14] reported bloody diarrhea in 94% and abdominal pain in 78% of UC patients. The abdominal pains are attributed to intestinal distension secondary to the disease itself, to fibrotic stricture, adhesions or following surgical interventions [17]. Thirty-eight per cent of UC patient in this study had history of weight loss at presentation.…”

“…Medical treatment of children with UC should consider both induction and maintenance phases [2,3]. Most clinicians rely on corticosteroids for induction of rapid remission [2,3,17,19,27,28]. However, one third of patients will fail to respond to corticosteroids [3].…”

“…azathioprine) and biologic agents (e.g. Infliximab (IFX) and adalimumab) are the main maintenance drugs used [2,3,17,27,28]. Mesalazine, at a dose of 2.4-4.8 g/day, is an effective therapy for patients with mild to moderate UC [3].…”

Anti-Inflammatory and Antinociceptive Action of an Orally Available Nociceptin Receptor Agonist SCH 221510 in a Mouse Model of Inflammatory Bowel Diseases

“…The major symptom of IBD is abdominal pain, which is described as a cramping sensation, varying in intensity and with exacerbations (Srinath et al, 2012). There are two types of abdominal pain: somatic, which is musculoskeletal; and visceral, caused by stretching of the viscera by obstruction or widely affected inflammation.…”