From the Guidelines
For managing abdominal pain during ulcerative colitis (UC) flare-ups, a multi-faceted approach is recommended, prioritizing addressing the underlying inflammation and utilizing a combination of brain–gut behavioral therapies and neuro-modulators early in the course of treatment, as suggested by the most recent study 1.
Key Considerations
- The goal of therapy is complete remission, defined as both symptomatic and endoscopic remission without corticosteroid therapy, as outlined in the Toronto consensus 1.
- Acute abdominal pain during episodes of inflammation is common among patients with IBD and generally disappears rapidly with appropriate medical therapy 1.
- In cases of persistent pain, central mechanisms of pain modulation are likely to play the primary role, and multidisciplinary care is most effective 1.
Pain Management Options
- Start with acetaminophen (Tylenol) at 650-1000mg every 6 hours as needed, not exceeding 4000mg daily, while avoiding NSAIDs like ibuprofen or naproxen as they can worsen UC symptoms.
- For more severe pain, antispasmodics such as dicyclomine (Bentyl) 10-20mg three to four times daily or hyoscyamine (Levsin) 0.125-0.25mg every 4 hours may be prescribed.
- Heat therapy using a heating pad on the abdomen for 15-20 minutes several times daily can provide relief.
Addressing Underlying Inflammation
- Continue taking prescribed UC medications like mesalamine, corticosteroids, or biologics to address the underlying inflammation.
- Dietary modifications during flares can help reduce pain—follow a low-residue diet avoiding high-fiber foods, spicy foods, caffeine, and alcohol.
- Stay well-hydrated with water and electrolyte solutions.
Additional Considerations
- Stress management techniques such as deep breathing, meditation, or gentle yoga may also help, as stress can exacerbate both pain perception and UC symptoms.
- Contact your healthcare provider if pain is severe, persistent, or accompanied by high fever, severe bleeding, or inability to keep fluids down, as these may indicate complications requiring immediate attention, as suggested by various guidelines 1.
From the FDA Drug Label
In a pediatric UC trial, the most common adverse reactions were upper respiratory tract infection, pharyngitis, abdominal pain, fever, and headache Abdominal pain 8% 12%
The pain management options for abdominal pain during an ulcerative colitis (UC) flare-up are not explicitly stated in the drug label. However, it is mentioned that abdominal pain is a common adverse reaction in patients with UC.
- Abdominal pain is reported in 8-12% of patients. No specific pain management options are provided in the label for abdominal pain during a UC flare-up 2.
From the Research
Pain Management Options for Abdominal Pain during UC Flare-up
- The primary goal of treatment is to induce and maintain clinical remission, which can help alleviate abdominal pain symptoms 3, 4.
- Mesalamine (5-ASA) is the first-line therapy for mild UC and can be effective in reducing abdominal pain 5, 3, 4.
- For patients with more severe UC, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used to induce and/or maintain remission, which can also help manage abdominal pain 3.
- Advanced therapies such as anti-TNF, anti-integrin, and anti-IL12/23 agents, as well as JAK inhibitors and sphingosine1-phosphate receptor modulators, may also be effective in treating UC and managing abdominal pain 5.
- Combination therapy, such as the use of infliximab biosimilar and azathioprine, may be considered for patients with persistent abdominal pain and UC flare-ups 6.
- The choice of treatment should be based on effectiveness, safety, and patient-specific factors, including disease features, patient preferences, and ongoing assessment of response to treatment 5, 7.