From the Guidelines
NSAIDs are not recommended for colitis pain due to their potential to worsen inflammation and trigger flares in inflammatory bowel disease. The most recent and highest quality study, published in 2021 1, highlights the importance of avoiding NSAIDs in patients with colitis, as they can increase the risk of immune-related adverse events, including colitis. Instead, acetaminophen (Tylenol) is the preferred over-the-counter pain reliever for patients with colitis, typically taken at 500-1000mg every 6 hours, not exceeding 3000mg daily. For more severe pain, a gastroenterologist might prescribe antispasmodics like dicyclomine (10-20mg three to four times daily) or hyoscyamine to relieve cramping. The primary approach to managing colitis pain is treating the underlying inflammation with medications such as aminosalicylates, corticosteroids, immunomodulators, or biologics as prescribed by a doctor.
Some key points to consider when managing colitis pain include:
- Avoiding NSAIDs due to their potential to worsen inflammation and trigger flares
- Using acetaminophen as a preferred over-the-counter pain reliever
- Considering antispasmodics for more severe pain
- Treating the underlying inflammation with medications such as aminosalicylates, corticosteroids, immunomodulators, or biologics
- Consulting a healthcare provider for appropriate pain management strategies tailored to the specific condition.
It's also important to note that the use of NSAIDs can damage the intestinal lining and increase gut permeability, which is particularly problematic in colitis where the intestinal barrier is already compromised 1. If pain persists despite these approaches, consulting a healthcare provider for further guidance is essential.
From the FDA Drug Label
NSAIDs should be given with care to patients with a history of inflammatory bowel disease (ulcerative colitis, Crohn’s disease) as their condition may be exacerbated.
- NSAID use in colitis: The use of NSAIDs, including naproxen, may exacerbate inflammatory bowel disease, such as ulcerative colitis.
- Caution is advised: Patients with a history of inflammatory bowel disease should be given NSAIDs with care, as their condition may worsen. The use of naproxen for colitis pain is not recommended due to the potential risk of exacerbating the condition 2.
From the Research
NSAID Use for Colitis Pain
- NSAIDs may exacerbate colitis or cause non-specific colitis, leading to symptoms such as bloody diarrhea, weight loss, and abdominal pain 3.
- The use of NSAIDs can increase the risk of gastrointestinal complications, including upper and lower GI complications 4.
- In patients with colitis, NSAIDs should be used with caution and under the guidance of a healthcare professional.
Alternative Treatment Options
- For acute severe ulcerative colitis, treatment options include intravenous corticosteroids, cyclosporine, or infliximab 5.
- For mild to moderate acute pain, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options, with topical NSAIDs recommended for non-low back, musculoskeletal injuries 6.
- Paracetamol (acetaminophen) is a suitable first-choice analgesic for many adults with mild to moderate acute pain, including those with liver, kidney, or cardiovascular disease, gastrointestinal disorders, asthma, or who are older 7.
Considerations for NSAID Use
- The risk of gastrointestinal adverse events associated with NSAID use should be considered, and prophylactic strategies such as co-therapy with PPI may be necessary 4.
- The prescription of type and dose of NSAIDs must be individualized based on the stratification of the CV and GI risk of patients 4.
- Patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease should use NSAIDs with caution 6.