From the Guidelines
Pain control in Crohn's disease should prioritize a multi-faceted approach that addresses both the underlying inflammation and the pain symptoms, with a focus on non-pharmacological interventions and careful use of medications. The most recent and highest quality study 1 suggests that acute abdominal pain during episodes of inflammation is common among patients with IBD, and generally disappears rapidly with appropriate medical therapy. However, in patients with persistent and chronic pain, central mechanisms of pain modulation are likely to play the primary role, and multidisciplinary care is most effective.
Some key considerations for pain management in Crohn's disease include:
- Controlling disease activity with medications like corticosteroids, immunomodulators, or biologics
- Using acetaminophen for mild pain, and avoiding NSAIDs due to their potential to worsen intestinal inflammation
- Considering antispasmodics like dicyclomine for cramping pain
- Using low-dose antidepressants like amitriptyline or duloxetine for moderate pain
- Avoiding opioids for chronic pain due to risks of dependence and potential worsening of gastrointestinal symptoms
- Incorporating non-pharmacological approaches like heat therapy, stress management, cognitive behavioral therapy, and gentle exercise to complement medication.
As noted in 1, it is essential to have an empathic, scientific, and firm approach when discussing pain management with patients, and to prioritize pain acceptance and psychological flexibility. Additionally, 1 highlights the potential benefits of non-pharmacologic interventions like exercise, soft-tissue mobilization, acupuncture, relaxation training, and mindfulness-based stress reduction in managing chronic abdominal pain in IBD.
Overall, a comprehensive and coordinated approach to pain management, incorporating both pharmacological and non-pharmacological interventions, is crucial for optimizing outcomes in patients with Crohn's disease. This approach should be guided by the most recent and highest quality evidence, and should prioritize the unique needs and circumstances of each individual patient 1.
From the FDA Drug Label
RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy
The best option for pain control in patients with Crohn's disease is not directly stated in the drug label. However, infiximab (IV), also known as RENFLEXIS, is indicated for reducing signs and symptoms of Crohn's disease, which may include pain.
- The recommended dose of RENFLEXIS for adult patients with moderately to severely active Crohn's disease is 5 mg/kg given as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter 2.
- It is essential to note that pain management should be individualized and may require additional treatments or therapies beyond RENFLEXIS.
- Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with RENFLEXIS.
From the Research
Pain Control Options for Crohn's Disease
Pain control is a crucial aspect of managing Crohn's disease, as patients often experience abdominal pain, among other symptoms. The following options are available for pain control:
- Medical management: This includes the use of anti-inflammatory drugs, such as corticosteroids, immunomodulators, and biological agents to reduce inflammation and induce remission 3.
- Individualized 'treat-to-target' (T2T) pharmacological and treatment approaches: This strategy involves setting specific treatment targets, such as achieving full clinical remission and full endoscopic healing, to improve symptom resolution and reduce the risk of inflammatory complications 4.
- Surgical management: In some cases, surgery may be necessary to drain abscesses, place setons, or perform definitive surgical therapies, such as fistulotomies, advancement flaps, and ligation of intersphincteric fistula tract procedures 5.
Considerations for Pain Control
When managing pain in Crohn's disease, it is essential to consider the following:
- The disease's variable clinical features and individual patient needs: Each patient's case must be managed individually, taking into account their unique symptoms, disease activity, and treatment response 6.
- The risk-to-benefit balance of treatment goals and selected therapeutic strategies: Patients and clinicians must weigh the potential benefits of treatment against the potential risks and side effects 4.
- The importance of a multidisciplinary approach: A team of healthcare professionals, including gastroenterologists, surgeons, and other specialists, may be necessary to provide comprehensive care and manage complex cases 5.
Current Treatment Options
Current treatment options for Crohn's disease aim to induce and maintain remission, reduce symptoms, and improve quality of life. These options include: