Recommendations for Clinicians

  • Regardless of the patient’s background or disease activity, remember that the abdominal pain is real and often debilitating for the patient.
  • Explain to the patient that abdominal pain often has multiple overlapping underpinnings.
  • Perform a comprehensive assessment, taking into account physical, psychological, neurobiological, and psychosocial domains.
  • Design an individualized treatment plan.
  • Taper the patient off narcotics.
  • Remember that visceral hypersensitivity can exist during disease flares and during remission.
  • Behavioral therapy has utility in all disease states.
  • Psychosocial therapies can be recommended adjunctively.

Conclusions and Future Approaches

The authors discuss novel anti-inflammatory medications under investigation, including cannabis, psychotherapy, and TENS and recommend future research “aimed at uncovering underlying mechanisms of pain perception” and examining therapeutic options.

References

1. Srinath A, Young E, Szigethy E. Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside. Inflamm Bowel Dis. 2014;20(12):2433-49. 

2. Cervero F, Laird JM. Visceral pain. Lancet. 1999 Jun 19;353(9170):2145-8. 

3. Mika J. Modulation of microglia can attenuate neuropathic pain symptoms and enhance morphine effectiveness. Pharmacol Rep. 2008;60(3):297-307. 

4. Malin S, Molliver D, Christianson JA, et al. TRPV1 and TRPA1 function and modulation are target tissue dependent. J Neurosci. 2011;31(29):10516-28.

5. Elsenbruch S. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun. 2011;25(3):386-94. 

6. Manchikanti L, Singh V, Datta S, et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12(4):E35-70. 

7. Vervoort T, Goubert L, Eccleston C, et al. Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain. J Pediatr Psychol. 2006;31(7):674-83. 

8. Makharia GK. Understanding and treating abdominal pain and spasms in organic gastrointestinal diseases: inflammatory bowel disease and biliary diseases. J Clin Gastroenterol. 2011;45 Suppl:S89-93. 

9. Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. 2003;98(11):2363-71. 

10. Takeuchi K, Smale S, Premchand P. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4(2):196-202. 

11. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999;340(24):1888-99. 

12. Kurlander JE, Drossman DA. Diagnosis and treatment of narcotic bowel syndrome. Nat Rev Gastroenterol Hepatol. 2014;11(7):410-8. 

13. Mishkin D, Boston FM, Blank D, et al. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn’s disease. Dig Dis Sci. 2002;47(3):489-94. 

14. Iskandar HN, Cassell B, Kanuri N, et al. Tricyclic antidepressants for management of residual symptoms in inflammatory bowel disease. J Clin Gastroenterol. 2014;48(5):423-9. 

15. Mikocka-Walus AA, Gordon AL, Stewart BJ, Andrews JM. A magic pill? A qualitative analysis of patients’ views on the role of antidepressant therapy in inflammatory bowel disease (IBD). BMC Gastroenterol. 2012;12:93. 

16. Wang YP, Chen YT, Tsai CF, et al. Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Am J Psychiatry. 2014;171(1):54-61. 

17. Palsson OS, Whitehead WE. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist. Clin Gastroenterol Hepatol. 2013;11(3):208-16. 

18. Berrill JW, Sadlier M, Hood K, Green JT. Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels. J Crohns Colitis. 2014;8(9):945-55 

This article originally appeared on MPR