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Chronic Pain in Inflammatory Bowel Disease: Characteristics and Associations of a Hospital-based Cohort

Morrison, Graham MB*; Van Langenberg, D. R. PhD*; Gibson, S. J. PhD; Gibson, P. R. MD*

doi: 10.1097/MIB.0b013e318280e729
Original Clinical Article

Background: Chronic pain (CP) is a common symptom in patients with inflammatory bowel disease. This study aimed to examine its prevalence, severity, clinical associations, and impact on psychological well-being and to identify patient factors that independently predict the presence of severe/disabling pain.

Methods: One hundred and twenty consecutive patients with inflammatory bowel disease attending a hospital-based clinic provided information through questionnaires on quality of life, mood disturbance, and functional gut symptoms. Those who had CP (pain occurring every day for 3 months within the past 6 months) provided additional information on the pain's intensity and associated disability and management and coping strategies.

Results: Forty-six patients (38%) had CP, most commonly in the abdomen (91%), and they had higher disease activity, reduced quality of life, and more depression and anxiety and took more paracetamol and opiates than those without. These indices were worse in the subgroup of 23 with moderate–severe pain/disability. Criteria for irritable bowel syndrome were met in 70% of those with pain irrespective of its severity. Multivariate analysis identified 4 independent associations with moderate–severe pain/disability: active disease (odds ratio, 49 [95% confidence intervals, 1.6–1455]), catastrophizing tendency (35 [3–228]), medication belief score (0.05 [0.005–0.55], and depression score (1.80 [1.02–3.17]).

Conclusions: CP has major effects on quality of life and functional and social outcomes. Active disease and maladaptive coping strategies and negative attitudes and beliefs toward symptoms are independently associated with more severe pain. Management strategies should move the focus away from analgesic dependence toward psychosocial intervention and nonpharmacologic therapy.

Article first published online 21 March 2013

*Eastern Health Clinical School, Eastern Health, Monash University, Melbourne, Australia; and

National Ageing Research Institute, Royal Melbourne Hospital, Melbourne, Australia.

Reprints: Graham Morrison, Department of Medicine and Gastroenterology, Altnagelvin Area Hospital, Glenshane Road, Londonderry BT 47 6SB, Northern Ireland (e-mail: grahammorrison@doctors.org.uk).

G. Morrison was in receipt of an IBD fellowship from Eastern Health Clinical School. D. R. van Langenberg was in receipt of a Postgraduate Scholarship from the National Health and Medical Research Council of Australia.

The authors have no conflicts of interest to disclose.

Received July 12, 2012

Accepted August 28, 2012

© Crohn's & Colitis Foundation of America, Inc.
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