Pain and Central Sensitization Characteristics in IBD

Among patients with inflammatory bowel disease (IBD), approximately 75% reported pain, according to results of a study published in the Journal of Crohn’s and Colitis.

Typically, abdominal pain in IBD is associated with inflammation and has the possibility of persisting in clinical remission. To date, central sensitization (CS) in patients with IBD has not been examined, according to the researchers. The objective of the current study was to explore the epidemiology of pain and to identify pain characteristics with a focus on CS in this patient population.

This prospective cross-sectional study was conducted at the Centre Hospitalier Universitaire de Liège in Belgium in 2020 to 2021. Patients (N=200) with IBD responded to a questionnaire about their pain symptoms and underwent a gastroenterological examination.

The patients with Crohn disease (CD; n=134) and ulcerative colitis (n=66) were aged mean 44.7 (range, 19-87) and 44.3 (range, 19-75) years, 44% and 51.5% were men, body mass index (BMI) was 23.8 (range, 20.9-27.2) and 24.6 (range, 22.1-27) kg/m², 63.4% and 24.2% had active disease (P <.001), the duration of IBD was 13.5 (range, 8-23) and 13.5 (range, 6-20) years, and 36.6% and 4.5% had undergone surgery for their IBD (P <.001), respectively.

More patients with UC reported any pain (83.6% vs 59.1%; P <.001) and abdominal pain (68.2% vs 48.5%; P =.006). Patients most often reported pain in the abdomen (80%) but more than half of patients reported extra-intestinal pain throughout the body.

Stratified by the presence of pain, those with symptoms were younger, more were women, they had lower BMI, more had CD, and more had undergone surgery for IBD (all adjusted P ≤.05).

Independent risk factors for pain included female gender (adjusted odds ratio [aOR], 2.89; 95% CI, 1.41-6.09; P =.004), CD (aOR, 2.99; 95% CI, 1.4-6.52; P =.005), and age (aOR, 0.97; 95 CI%, 0.94-0.99; P =.02).

Pain was associated with higher scores for anxiety (mean, 9 vs 4; adjusted P =.003), depression (mean, 5.5 vs 2; adjusted P =.003), and total quality of life (mean, 22 vs 4; adjusted P =.003).

Stratified by the presence of  CS (28.5%), those with CS were older, more had extra-intestinal manifestation, had active disease, they had higher Harvey-Bradshaw Index (HBI) scores, and higher Partial Mayo Scoring Index Assessment (PRO2) scores (all adjusted P ≤.05).

The only independent predictor for CS was HBI scores (aOR, 1.29; 95% CI, 1.1-1.5; P =.001).

More patients with CS endorsed higher scores for the pain descriptors of annoying, unbearable, haunting, frightful, exhausting, heavy, tingling, burning, crushing, and electric shock (all adjusted P ≤.05).

CS was associated with higher scores for quality of life (mean, 39 vs 18; adjusted P =.003) but not anxiety or depression.

This study was limited by using the Douleur Neuropathique 4 (DN4) instrument to diagnose and define CS, however, the DN4 tool has only been validated for neuropathic pain and not for nociplastic pain.

The researchers concluded, “Our study demonstrates that the prevalence of pain, both abdominal and extra-intestinal, mainly joint pain, is high in IBD patients and at least partly disconnected from the activity of the disease. […] Pain with CS occurs in a quarter of patients with abdominal pain. […] The difficulty managing pain associated with CS and the high prevalence of rheumatic pain complicate pain management in IBD patients and should therefore prompt a multidisciplinary approach with pain medicine specialists and rheumatologists.”

Reference

Hardy P-Y, Fikri J, Libbrecht D, Louis E, Joris J. Pain characteristics in patients with inflammatory bowel disease: A monocentric cross-sectional study. J Crohns Colitis. Published online April 4, 2022. doi:10.1093/ecco-jcc/jjac051