What is the relationship between abdominal pain and Crohn's disease (Regional Enteritis)?

From the Guidelines

Abdominal pain is a common symptom of Crohn's disease and should be managed with a multidisciplinary approach, including brain-gut behavioral therapies and neuro-modulators, in addition to medical therapy, to address central mechanisms of pain modulation and improve quality of life. When managing abdominal pain in Crohn's disease, it's essential to consider the latest evidence, which suggests that acute abdominal pain during episodes of inflammation is common and generally disappears rapidly with appropriate medical therapy 1. However, in cases where abdominal pain persists and becomes chronic, central mechanisms of pain modulation are likely to play a primary role, and a multidisciplinary approach is most effective 1. Some key considerations for managing abdominal pain in Crohn's disease include:

• Medications: anti-inflammatory drugs, immunomodulators, and biologics may be used to reduce intestinal inflammation and alleviate symptoms
• Pain management: acetaminophen may be used for mild pain, while avoiding NSAIDs, which can worsen Crohn's symptoms
• Lifestyle changes: diet modifications, stress reduction, and regular monitoring can help alleviate symptoms and prevent flares
• Multidisciplinary care: brain-gut behavioral therapies and neuro-modulators should be considered early in the course of treatment to address central mechanisms of pain modulation The approach to management should combine appropriate deployment of medical, surgical, and/or endoscopic treatment with timely information and support, aiming to improve or completely resolve symptoms, improve or restore quality of life, avoid hospitalization, and promote endoscopic mucosal healing while minimizing adverse events 1.

From the FDA Drug Label

The types and frequencies of adverse reactions observed were similar in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis and Crohn's disease patients treated with infliximab except for abdominal pain, which occurred in 26% of patients with Crohn's disease

• Abdominal pain is a common adverse reaction in patients with Crohn's disease, occurring in 26% of patients.
• The relationship between abdominal pain and Crohn's disease is that abdominal pain is a frequent symptom of the disease, as supported by the high incidence of abdominal pain in patients with Crohn's disease treated with infliximab 2.

From the Research

Relationship between Abdominal Pain and Crohn's Disease

The relationship between abdominal pain and Crohn's disease is complex and multifaceted. Abdominal pain is one of the most common and impactful symptoms associated with Crohn's disease, a remitting and relapsing disorder that can affect the whole gastrointestinal tract 3.

Causes of Abdominal Pain in Crohn's Disease

Abdominal pain in Crohn's disease can be a symptom of disease relapse or related to medication adverse effects, surgical complications, and strictures or adhesions secondary to the disease 4. In some cases, abdominal pain can also be associated with elevated inflammatory markers, anxiety, depression, and smoking 5.

Treatment of Abdominal Pain in Crohn's Disease

There is no standard and effective treatment for abdominal pain in Crohn's disease, and the evidence underlying treatment options is limited 3, 4. Some studies have investigated the efficacy of various interventions, including:

• Low FODMAP diet: The evidence on pain intensity is of very low certainty, and no conclusions can be drawn about the efficacy of this treatment 4.
• Mindfulness with CBT: The evidence is very uncertain about the effect of this treatment on pain intensity and frequency 4.
• Soft non-manipulative osteopathic treatment: The evidence is very uncertain about the effect of this treatment on pain intensity 4.
• Stress management: The evidence is very uncertain about the effect of this treatment on pain intensity 4.
• Enteric-release glyceryl trinitrate: The data reported on pain intensity is unclear 4.
• Olorinab: The evidence is very uncertain about the effect of this treatment on pain intensity 4.
• Transcranial direct current stimulation: There may be an improvement in pain intensity when transcranial direct current is compared to sham stimulation, but the certainty of the evidence is low 4.

Surgical Treatment of Crohn's Disease

Surgery is often unavoidable in cases of complications such as fistulas, abscesses, or strictures, and is typically indicated when these complications occur 6. The treatment requires close cooperation between gastroenterologists and surgeons, and surgery should be performed in a 'conservative' fashion to achieve the required result and avoid small bowel syndrome 6.

Management of Abdominal Pain in Crohn's Disease

The management of abdominal pain in Crohn's disease requires a comprehensive approach, taking into account the patient's condition and willingness to develop an effective treatment plan 7. Clinicians need to improve their knowledge of these conditions and update the treatment consensus guidelines in a timely manner 7.