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Pain Management With Crohn's Disease

Medically Reviewed by Minesh Khatri, MD on June 16, 2022

If you have Crohn’s disease and pain, it’s a good idea to talk to your doctor. Pain is common with Crohn’s, but there are ways to treat it.

What Is Pain Management for Crohn’s Disease?

Pain management can help control your discomfort related to Crohn’s. You may notice two main types of pain:

Visceral pain. This happens inside your body and it’s hard to locate.

Somatic pain. This affects your muscles, joints, and bones. It’s easier to find exactly where the pain comes from.

Your doctor can help figure out where your pain is coming from and how to best treat it. They’ll create a plan that includes medication, therapy, and other lifestyle changes. This can improve your quality of life with Crohn’s.

When Do You Need Pain Management for Crohn’s Disease?

Pain might be your only sign that your Crohn’s disease is getting worse. It’s important to let your doctor know if you’re having pain because it might mean you need stronger or different sorts of therapy.

You might notice different types of pain from your Crohn’s disease. Some reasons might be:

  • Inflammation in your intestines
  • Abscesses (swollen areas on your body with pus) or strictures (an area that narrows in your body)
  • Partial small-bowel blockage
  • Poor absorption of bile acid, which can lead to diarrhea and cramping
  • Joint pain
  • Mouth sores
  • Erythema nodosum, a disorder that causes tender bumps under your skin
  • Pyoderma gangrenosum, a condition that leads to large and painful sores on your skin
  • Iritisis, swelling and irritation in your eye’s pupil
  • Uveitis, inflammation in your eyes that can happen if your body is fighting an infection
  • Chronic liver disease known as primary sclerosing cholangitis

What Makes Crohn’s-Related Pain Worse?

If your pain with Crohn’s is getting worse, there are several reasons that might be happening.

It can get worse if you also have an anxiety disorder or depression. Your pain might also get worse if you have severe, ongoing, or past stress, such as trauma.

Also, the stress of getting a Crohn’s diagnosis, and having medical procedures to treat it, can make your pain worse.

Experts have also begun to explore how your microbiome affects your pain. That’s the collection of all the microbes (like bacteria) that live in your body. Every time your Crohn’s flares up, nerve endings in your intestines come into contact with harmful agents. This could lead to more pain, even when your inflammation is gone.

How Can You Treat Crohn’s-Related Pain?

Pain management is different for everyone. Your best option may depend on the details of your Crohn’s. Your doctor will help you find the treatment best for you.

Some options include:

Non-opioid analgesics. It’s safe to use acetaminophen with Crohn’s disease unless you have underlying liver issues. You can take up to 4,000 milligrams a day. If you’re older, you shouldn’t take more than 3,000 milligrams a day.

Tricyclic antidepressants and selective norepinephrine inhibitors (SNRIs). These drugs work with your central nervous system. Tricyclic antidepressants and SNRIs can make healthy changes in your gut. This can help relieve stress and lower pain signals to your brain.

Even low doses of tricyclic antidepressants can help the intensity of your Crohn’s-related pain.

Anticonvulsants. Gabapentinoids (gabapentin or pregabalin) are types of anticonvulsants that can block pain signals from your spinal cord. They can also heighten the release of noradrenaline, which is a chemical that helps relieve pain. Experts continue to study these drugs to see how well they can help with abdominal pain.

Anticholinergics/antispasmodics. If you're working toward remission with your Crohn's disease, these drugs can help in the meantime. They can help reduce pain if other medical therapies don’t help.

Opioids. These drugs can help pain in your intestines. They can also block pain signals from your brain. But if you use too many opioids, you could worsen your Crohn's disease and the pain that comes with it.

Stop smoking. Smoking can worsen your Crohn’s disease. If you stop smoking, you can improve the overall health and the well-being of your digestive tract. You may improve your condition so much by quitting that you won’t need to take corticosteroids or immunosuppressive therapy anymore.

Exercise. Some experts believe the stress relief from regular physical activity can also improve symptoms of Crohn’s disease. With more exercise, you’ll improve your overall physical well-being, which can also help with Crohn’s-related symptoms.

Nutrition. Some foods can irritate your Crohn’s disease. They can cause bloating, abdominal pain, cramping, or discomfort. Avoid foods that make you feel bad or cause discomfort. This may be different for each person.

Medical marijuana. Some people with Crohn’s-related pain find that medical marijuana eases their symptoms. A few studies suggest that marijuana can help with pain relief, nausea, appetite, and sleep.

But experts don’t exactly know why marijuana eases this type of pain. More research may help explain the link.

If you want to try marijuana for your Crohn’s symptoms, talk to your doctor about it. They can help you get medical cannabis from a licensed and safe producer.

Cognitive behavioral therapy and mindfulness-based therapy. Through these therapies, you can learn how to respond to your thoughts, feelings, and behaviors in a healthy way. Mindfulness involves meditation and breathing routines. This can help treat the chronic pain and potential anxiety or depression caused by Crohn’s disease.

Yoga and breathing. Deep breathing in yoga can lead to relaxation. You may be able to ease some of your Crohn’s-related pain by reducing your stress.

Acceptance and commitment therapy. With this method, you’ll learn to accept and commit to changing your behavior for the better. This can help relieve Crohn’s pain linked to stress.

Biofeedback. With biofeedback, you can relax your muscles and lower your heart rate. This can help you learn to cope with stress better. A study has shown that biofeedback, in addition to relaxation, education, and cognitive coping methods, can lower pain in people with Crohn’s disease.

Hypnotherapy. This therapy option involves a guide putting you in a trance-like state. Some experts have found that hypnotherapy may help if you have abdominal pain from Crohn’s.

Transcutaneous electrical nerve stimulation (TENS). This process uses sticky electrodes on your skin. They send electricity to block pain signals in certain areas of your body. This can help with Crohn’s pain in your intestines.

Therapeutic endoscopy. Crohn’s can cause painful strictures. These are areas in your intestines that narrow due to scar tissue from inflammation. They may lead to a blockage. To treat these, you can use a therapeutic endoscopy procedure called endoscopic balloon dilation.

Surgery. Your doctor may recommend surgery if you have a stricture, depending on how intense it is, where it’s located, and its size. You might develop adhesions after your surgery. These are bands of scar tissue. The only way to get rid of them (if they cause pain) is through another surgery.

Remember as you look for ways to treat your Crohn’s-related pain, you should avoid nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen, naproxen, ketorolac, and others. These can cause your Crohn’s to flare up.

Show Sources

SOURCES:

Crohn’s and Colitis Foundation: “Pain Management for IBD Patients.”

Gastroenterology and Hepatology: “Managing Pain in Inflammatory Bowel Disease,” “Pain Management in Patients With Inflammatory Bowel Disease.”

Crohn’s and Colitis Canada: “Pain and IBD.”

Therapeutic Advances in Gastroenterology: “Pain management in patients with inflammatory bowel disease: insights for the clinician.”

Cleveland Clinic: “Pain Management.”

Crohn’s and Colitis 360: “Medicinal Cannabis for Inflammatory Bowel Disease: A Survey of Perspectives, Experiences, and Current Use in Australian Patients.”

Expert Review of Gastroenterology & Hepatology: “An overview of cannabis based treatment in Crohn's disease.”

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