Pain Management in IBD

| LEADING ARTICLE | PAIN MANAGEMENT IN IBD 1 Address for correspondence: Address for correspondence: Douglas A Drossman, MD, Professor of Medicine and Psychiatry, Co-Director UNC Center for Functional GI and Motility Disorders, 4150 Bioinformatics, CB#7080, University of North Carolina, Chapel Hill, NC 27599–7080, USA. Email: [email protected] Abdominal pain is a common symptom of IBD [1,2] that may indicate an acute flare and subside with treatment to reduce disease activity. It can arise from several causes such as severe inflammation or abscess formation, or obstruction with secondary gut distension. However, in clinical practice, just as we can see patients with IBD having little or no pain with severe inflammation, we also see patients who experience pain when the disease is inactive. Thus, while there is an association between pain and disease activity in IBD, the degree of association is variable and incomplete. Pathophysiological mechanisms such as neurovisceral sensitization from minimal inflammation, or impaired central modulation of pain via dysregulation of cingulate cortical activity, as seen in irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs), help explain the presence of pain with minimal inflammation [3]. Psychosocial distress can enable these mechanisms in both FGIDs and structural diseases. As IBD is a chronic disease with impairment of quality of life (QoL), there can be a significant burden of psychosocial difficulties in the illness experience of patients with the disease. Therefore, it is important to understand IBD from a biopsychosocial context rather than as an “organic” disorder, where psychosocial relationships may be ignored [4]. This more comprehensive biopsychosocial framework in IBD integrates the histopathological and psychosocial contributions to explain the illness, including symptoms of pain, and permits more effective treatments. In this article, a modern and more comprehensive understanding of pain in IBD that ultimately will improve clinical management is addressed.