Pain and IBD

Pain is one of the most common symptoms of IBD, commonly reported when one first begins experiencing symptoms (i.e., IBD onset) and when IBD relapses or worsens. Between 50 – 70% of people will report pain during a flare-up. Although pain is closely coupled with inflammation – and pain usually disappears with IBD remission – around 1 in 5 patients in remission will continue to experience pain. Our current understanding of pain in IBD suggests that it is a complex relationship between our thoughts, emotions, and the neural pathways that connect our digestive tract and central nervous system.

Our bodies are constantly in a state of motion, and the brain is constantly bombarded with sensory information from the digestive tract. This sensory information is usually routine and benign, and it often takes a significant pain or discomfort for us to take notice. In people with active IBD, however, the neural pathways from the gut to the brain appear at times to become hypersensitive to these sensations. These sensations, which would have otherwise gone unnoticed (i.e., in a healthy person), may be experienced as painful or uncomfortable. This sensitisation of neural pathways is suggested as a potential reason for persistent pain sometimes observed in healthy (remission) IBD patients.

Beyond this, research suggests that the brain canalso modulate the sensory information received from the gut. That is, the brain can facilitate or reduce the sensory information from the gut (e.g., contractions, distention, pain) to the brain. The brain can also increase the impact of gut sensations through hypervigilance, or anxiously looking for and attending to signs of gut discomfort. The experience of pain can trigger feelings of anxiety which can, in turn, increase hypervigilance towards gut sensations.

What can I do?

Pain relief often comes with getting one’s IBD under control. There may be medication options available as well but discuss this with your doctor, as some pain relief medications (e.g., non-steroidal anti-inflammatories [NSAIDs]) can potentially worsen IBD. If your doctor is satisfied that you are in remission, but you are still experiencing pain, consider seeing a mental health professional specialising in gastrointestinal conditions or other chronic pain conditions.