It is very common for people who have inflammatory bowel disease (IBD), including Crohn’s disease(CD) and ulcerative colitis, to report that they experience pain due to the disease.1 A range of symptoms and complications related to the disease can be sources of pain. Pain experienced by people with IBD can have a variety of causes, including:
- Pain caused by inflammation
- Pain caused by surgical complications
- Pain caused by bacterial overgrowth in the digestive tract2
Experiencing pain can significantly affect a person’s quality of life, and can cause anxiety if the pain is uncontrollable or long lasting. For this reason, healthcare providers work with patients to develop a pain management strategy to help control and reduce pain.
Inflammatory sources of pain with ulcerative colitis and Crohn's
IBD is a condition caused by chronic inflammation in the digestive tract. This inflammation frequently causes symptoms and complications that are sources of pain, including:1
- Gastritis – inflammation of the stomach lining
- Enteritis – inflammation of the intestine
- Colitis – inflammation in the colon, which is entirely different than ulcerative colitis
- Abscess – an area of infection that is filled with pus
- Fistula – a tunnel that forms between an organ and another part of the body
- Fissure – a small tear in the tissues that line the anus
IBD can also cause symptoms and complications that occur outside of the digestive tract. These sources of pain are called extraintestinal, and can include:1
- Peripheral arthritis – inflammation of the large joints of arms and legs (elbows, wrists, knees, and ankles)
- Sacroiliitis – inflammation in the area where the lower spine connects to the pelvis
- Ankylosing spondylitis – inflammation that causes the vertebrae in the spine to fuse together
- Primary sclerosing cholangitis – inflammation that scars and damages the bile ducts in the liver
- Erythema nodosum – skin inflammation that causes red, painful lumps
- Pyoderma gangrenosum – chronic, deep ulcers on the skin
Common non-inflammatory sources of pain
Inflammation is not the only source of pain caused by IBD. Non-inflammatory sources of pain in the digestive tract include:1,2
- Strictures – narrowing of the intestines
- Adhesions – bands of scar tissue that can develop after surgery
- Small-bowel obstruction
Non-inflammatory sources of pain due to IBD that are outside the digestive tract include:1
- Kidney stones
- Gallstones
Managing pain with ulcerative colitis and Crohn's
The first step in developing a pain management approach for a patient with IBD is to determine what is causing the pain. If active IBD is causing the pain, then the first strategy is generally for healthcare providers to change or increase the medication that the patient is taking to manage the disease, such as aminosalicylates, corticosteroids, antibiotics, immunosupressants, or biologics. In many cases, treating the disease and its symptoms can be effective in reducing pain.1
However, some people may continue to experience pain despite the change in medication, or they may have pain that is not due to active IBD but some other cause. In those cases, healthcare providers may recommend trying some kind of pain relievers.
What pain relievers can be used for IBD?
The most common type of over-the-counter pain relievers are called NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen (Advil or Motrin), aspirin, or naproxen. These medications are generally not recommended for people with inflammatory bowel disease because of the side effects that they can cause in the digestive tract. This means that taking NSAIDs for pain relief can cause the symptoms of IBD to get worse or trigger IBD flare-ups that can cause further damage to the digestive tract.1,2
Patients with IBD should consult their healthcare providers before taking any NSAID medications. In some cases, NSAIDs may be recommended for treating pain due to arthritis, but patients will be monitored closely for side effects. Instead of NSAIDs, people with IBD may be advised to try acetaminophen (Tylenol) for pain relief.1,2
Opiates are a very strong type of medication that can be used to treat severe pain. They include morphine, hydrocodone with acetaminophen (Vicodin), oxycodone with acetaminophen (Percocet), and codeine. While they can be very effective at treating severe pain in the short term, if they are taken long-term, opiates can cause serious side effects and can make a person physically dependent on them. For this reason, they should be taken only under close supervision from a healthcare provider.1,2