Managing Abdominal Pain in IBD: A Review

Patients with IBD often report abdominal pain, which is frequently undertreated
Patients with IBD often report abdominal pain, which is frequently undertreated

A review published in Alimentary Pharmacology & Therapeutics reports that relaxation, cognitive behavioral therapy and stress management appear to be beneficial for inflammatory bowel disease (IBD) patients with abdominal pain, in addition to dietary modifications.

Patients with IBD, and even those in remission, often report abdominal pain, which is often undertreated. To get a better understanding of what treatments may be effective, the researchers looked for studies that included interventions for managing abdominal pain in IBD; disease-modifying interventions were not included in the systematic review.

After searching various databases, the study authors identified 13 intervention studies and two cross-sectional surveys. The papers evaluated various psychological, dietary, and drug interventions. 

Pain reduction was observed in four out of six studies with psychological intervention, including individualized and group-based relaxation, disease anxiety-related cognitive behavioral therapy and stress management. Patients with inactive Crohn's disease experienced pain reduction from both psychologist-led and self-directed stress management vs. controls (symptom frequency reduction index: –26.7, –11.3, and 17.2 at 6-month follow-up, respectively). 

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High-sugar alcoholic drinks were associated with abdominal pain in a small study of inactive Crohn's disease patients (n=20) while a fermentable carbohydrate with prebiotic properties was found to reduce abdominal pain in 20 IBD patients. Antibiotics and transdermal nicotine patches were also found to lower abdominal pain. 

One trial evaluating cannabis use showed a reduction in SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). 

The study authors state that the data should be interpreted with caution as the evidence came from "predominantly small uncontrolled studies of moderate to low quality. The findings show only a small number of interventions have been studied for IBD abdominal pain. "There is a need to develop interventions for abdominal pain management in IBD," added the authors.

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