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Musculoskeletal Pain in Individuals With Inflammatory Bowel Disease Reflects Three Distinct Profiles

Falling, Carrie, BPhty(Hons)*; Stebbings, Simon, FRACP-FRCP; Baxter, George D., PhD*; Gearry, Richard B., FRACP; Mani, Ramakrishnan, PhD*

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 559–568
doi: 10.1097/AJP.0000000000000698
Original Articles

Objectives: Pain affects over 70% of individuals with inflammatory bowel disease (IBD), with abdominal and musculoskeletal pain representing the most common symptoms. Musculoskeletal pain in IBD is reported to be associated with multiple clinical features, however the scope and nature of pain is not well understood. Primary aims were to identify subgroups of musculoskeletal pain in individuals with IBD based on clinical features of pain and assess how these subgroups differ in aspects of demographics, comorbidity, and IBD characteristics.

Methods: Cross-sectional online survey was performed on adults with IBD. Domains included: demographics, comorbidity, and clinical IBD and pain features. Latent class analysis was used to identify subgroups with similar attributes of: pain (severity, location, interference, and quality), IBD (activity, quality of life, and abdominal pain), and symptoms related to central sensitization. Correlation and regression analyses were used to profile identified subgroups.

Results: Of 305 included participants, 208 indicated the presence of musculoskeletal pain. Three identified subgroups were characterized as “mixed mechanism,” “central mechanism,” and “regional and remission.” Between subgroup differences included: total comorbidity score (P=0.005), osteoarthritis (P=0.027), osteoporosis (P=0.045), depression (P=0.001), anxiety (P=0.025), and chronic fatigue syndrome (P=0.020). Sex and age were identified as confounders for depression and anxiety.

Conclusions: Study results suggest multiple mechanisms contributing to pain experiences in IBD, to include central mechanisms. Features related to demographics, extraintestinal manifestations, IBD subtype, and clinical IBD features were not predictors of subgroup membership. However, total comorbidity demonstrated association with pain subgroups in this population.

*School of Physiotherapy

School of Medicine, University of Otago, Dunedin

Department of Medicine, University of Otago, Christchurch, New Zealand

The authors declare no conflict of interest.

Reprints: Carrie Falling, BPhty(Hons), 325 Great Kings Street, Dunedin 9010, New Zealand (e-mail:

Received August 12, 2018

Received in revised form February 1, 2019

Accepted February 20, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.