Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn's disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations.
Keywords sensitization; hyperalgesia; inflammatory bowel disease
PREVALENCE AND IMPACT OF PAIN ON IBDPain is an important manifestation of inflammation, as inflammatory cytokines and mediators sensitize primary afferent neurons. It should thus not be surprising that pain is 1 of the presenting symptoms in about 50%-70% of patients experiencing the initial onset or exacerbations of inflammatory bowel disease (IBD).1 , 2 However, ongoing and/or severe inflammation does not suffice to explain pain in IBD patients, as about 20% of patients in clinical and even endoscopic remission continue experiencing significant symptoms. Up to one-sixth of IBD patients are chronically treated with opioids. 3 -5 Physicians and patients typically think of pain as an alarm symptom that is triggered by high intensity and potentially noxious stimuli. This physiologic role of pain as an indicator of impending injury