Pain in IBD Associated With Cognitive and Behavioral Factors

ulcerative colitis
ulcerative colitis
Emotions, cognitions, and behaviors are significantly associated with pain severity and pain-related interference in IBD, including pain-specific cognitions and behaviors.

Patients with inflammatory bowel disease (IBD) reported higher levels of pain depending on their mental health, according to the results of a cross-sectional study conducted by researchers at King’s College London in the United Kingdom and published in the European Journal of Gastroenterology and Hepatology.

Patients with IBD were recruited from outpatient clinics (n=114) and online (n=183), all patients (N=297) were adults age 36.03±12.71 years. Each patient responded to a validated questionnaire that assessed pain and sociodemographic, clinical, cognitive, emotional, and behavioral characteristics.

Most patients reported pain (81.8%). Of those patients, 153 (63%) had Crohn disease and 90 (37%) had ulcerative colitis. The investigators reported that 40.3% of patients had the clinical criteria for chronic pain and opioid use was reported by 18.5% of patients.

A higher percentage of the women reported pain compared with women with no pain (67.9% vs 25%, respectively). In the pain cohort, patients were more likely to smoke, be unemployed, and have low educational attainment (P <.05). Patients who experienced pain were significantly more likely to report symptoms of depression (P <.001), stress (P <.001), and anxiety (P =.001).

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The investigators modeled both pain severity and pain interference in the patient population. Their model accounted for a total of 45.6% of the variance observed in pain severity, specifically due to sociodemographic factors (17.6%), clinical factors (17.9%), and psychosocial factors (9.5%). The model accounted for a similar amount of the variance observed in pain interference (49.7%), specifically due to sociodemographic (8.9%), clinical (16.2%), and psychosocial factors (24.0%).

One study limitation is that the patient cohort recruited online self-reported their disease severity. It is unclear if this self-reporting was medically accurate, especially because the online cohort reported higher disease activity, pain, and psychological factors.

The pain endured by patients with IBD was significantly associated with behavioral and cognitive features. The investigators identified potential targets for intervention that may placate some discomfort in patients with IBD-related pain.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Sweeney L, Moss-Morris R, Czuber-Dochan W, Murrells T, Norton C. Developing a better biopsychosocial understanding of pain in inflammatory bowel disease: a cross-sectional study. Eur J Gastroenterol Hepatol. 2020;32(3):335-344.