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Psychological, dietary interventions show promise for treating abdominal pain in IBD
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Limited evidence from a systematic review shows psychological interventions focusing on relaxation and stress management, as well as certain dietary interventions, are promising treatment strategies for recurring abdominal pain in patients with inflammatory bowel disease.
Other strategies shown to be effective in small studies included antibiotics, transdermal nicotine patches and cannabis.
“Despite IBD patients’ frequent reports of chronic abdominal pain, only a few interventions have been tested in this population to alleviate the symptom or to improve pain perception and management,” Christine Norton, PhD, MA, RN, of the Florence Nightingale Faculty of Nursing at King’s College London, and colleagues wrote. “The current limited evidence suggests that learning to manage pain through relaxation or cognitive techniques may be the most promising approaches, possibly with some individualized dietary changes. Pharmacological treatment and marijuana use show some short-term benefits.”
Norton and colleagues reviewed studies on non–disease-modifying IBD-related abdominal pain management interventions published up to February 2016, and ultimately included 13 intervention studies (n = 370) and two cross-sectional surveys (n = 555) in their analysis. Abdominal pain was the primary outcome of three studies and a secondary outcome in the remainder.
Six studies evaluated psychological interventions, four of which found pain was reduced with individualized and group-based relaxation, disease anxiety-related cognitive behavioral therapy, and stress management. For example, one study of patients with inactive Crohn’s disease showed stress management, either led by a psychologist or self-directed, both resulted in greater reductions in abdominal pain compared with control interventions (P < .05), and these improvements were maintained up to 1 year.
Three studies evaluated dietary interventions, one of which suggested that alcoholic drinks with higher sugar content (ie, beer rather than wine) were associated with abdominal pain in patients with Crohn’s disease. Another small study showed a fermentable polysaccharide prebiotic supplement was well tolerated and associated with reduced abdominal pain at 1 and 2 weeks (P .001).
Six studies evaluated pharmacological interventions, one of which was a randomized controlled trial that showed patients with Crohn’s disease and confirmed small bowel bacterial overgrowth experienced improved abdominal pain after receiving antibiotics (P = .04).
Another randomized controlled trial showed patients with active ulcerative colitis experienced reduced abdominal pain at 6 weeks after treatment with transdermal nicotine patches (P = .05).
Finally, three studies evaluated the effect of cannabis on IBD-related abdominal pain. Two were cross-sectional surveys that showed individuals with IBD reported that marijuana improved their abdominal pain symptoms. The other was a single-arm open-label pilot study (n = 13) that showed improvements in abdominal pain and general well-being after 3 months of treatment with inhaled cannabis. Norton and colleagues emphasized that these results should be interpreted with caution due to the size and quality of available studies.
“The scarcity of evidence warrants further research into the development and testing of interventions for abdominal pain management in IBD,” Norton and colleagues concluded, but recommended that based on these data, physicians should consider referring their patients to a dietitian or for psychological support in IBD patients experiencing recurrent abdominal pain. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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