From the Guidelines
For pain control in ulcerative colitis, mesalamine is the most effective medication, and it is recommended to use standard dose mesalamine (2–3 grams/day) or diazo-bonded 5-ASA as the first-line treatment. This recommendation is based on the American Gastroenterological Association (AGA) clinical practice guidelines on the management of mild-to-moderate ulcerative colitis, which suggests using either standard dose mesalamine or diazo-bonded 5-ASA rather than low dose mesalamine, sulfasalazine or no treatment 1.
When considering pain management, it's essential to prioritize treating the underlying inflammation, as this will have the most significant impact on reducing pain and improving quality of life. The AGA guidelines suggest that in patients with extensive or left-sided mild-moderate ulcerative colitis, adding rectal mesalamine to oral 5-ASA may be beneficial 1.
Some key points to consider when managing pain in ulcerative colitis include:
- Using standard-dose oral mesalamine or diazo-bonded 5-ASA as the first-line treatment
- Adding rectal mesalamine to oral 5-ASA for patients with extensive or left-sided mild-moderate ulcerative colitis
- Avoiding NSAIDs like ibuprofen and naproxen, as they can worsen colitis symptoms and trigger flares
- Considering antispasmodics such as dicyclomine or hyoscyamine for severe cramping
- Using heat therapy, stress reduction techniques, and dietary modifications to manage pain and reduce symptoms.
It's crucial to work closely with a healthcare provider to develop a personalized treatment plan that addresses the underlying inflammation and manages pain effectively, as severe or persistent pain may indicate a flare requiring adjustment of the UC treatment regimen 1.
From the Research
Medications for Pain Control in Ulcerative Colitis (UC)
The following medications are used for pain control and management of UC:
- Mesalamine, a 5-aminosalicylic acid compound, is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate UC 2, 3
- Corticosteroids, such as prednisolone, are used in UC patients with moderate to severe disease activity, but only for remission induction therapy due to side effects associated with long-term use 4
- Thiopurines, such as azathioprine/mercaptopurine, are used in patients who are refractory to mesalamine or have more severe disease 2, 4
- Biologic agents, such as infliximab, vedolizumab, and anti-TNF agents, are used in patients with severely active UC refractory to corticosteroids 4, 5
- JAK inhibitors and sphingosine1-phosphate receptor modulators are newer advanced therapies that are effective in treating UC 5
Treatment Approaches
Treatment approaches for UC depend on the severity, localization, and history of IBD medication, and may involve:
- Step-up approach, starting with 5-aminosalicylic acid compounds for mild to moderately active UC 4
- Combination therapy, using concomitant immunomodulators (thiopurines/methotrexate) with biologic agents to lower the rate of immunogenicity 4
- Therapeutic drug monitoring (TDM) to optimize treatment and minimize side effects 4
Considerations for Choosing Therapies
Choosing therapies for UC involves considering multiple factors, including: