Managing stress and changing the diets of patients with inflammatory bowel disease (IBD) may help mitigate abdominal pain, a British study suggests.

The systematic review, “Interventions for abdominal pain management in inflammatory bowel disease,” appeared in the journal Alimentary Pharmacology and Therapeutics.

IBD patients, including those with ulcerative colitis and Crohn’s disease as well as those in remission, frequently complain of chronic abdominal pain. However, pain in IBD is under-recognized, under-treated and under-researched, says the study.

Factors contributing to IBD pain include inflammation, post-inflammatory sensitization, bacterial overgrowth in the intestine, food intolerances and disease-induced morphological alterations. Psychological symptoms such as stress, anxiety or depression, sleep disturbance and medications also influence the perception of pain.

The use of analgesics, including opioids, to manage IBD pain may exacerbate symptoms, cause side effects or mask a relapse. Moreover, opioids’ benefits may not be significantly strong or long-lasting, and their use might also stigmatize patients as addicts. Yet relaxation and psychotherapy — along with dietary changes — are promising approaches.

Christine Norton, a professor at King’s College London, led a team that reviewed interventions for abdominal pain management in IBD patients. Their analysis of 15 studies revealed a variety of psychological interventions such as individualized and group-based relaxation; in fact, stress management reduced pain in four of six studies. Moreover, both psychologist-led and self-directed stress management in inactive Crohn’s disease ameliorated pain for as long as 12 months.

Antibiotics, transdermal nicotine patches and cannabis also mitigated pain, though dietary interventions led to mixed results. Alcoholic drinks with higher sugar content caused more pain, whereas fermented carbohydrates with probiotic properties reduced it. Studies published after the database research had been carried out further suggested that a low fermentable carbohydrate diet could effectively decrease abdominal pain in IBD.

Overall, the study stresses the need to pay more attention to IBD pain, including in patients with controlled disease. Despite the limited evidence, it said, doctors should consider making referrals to psychologists or dietitians. “It is likely that a range of pharmacological, nonpharmacological and dietary manipulation will provide the best effects for patients,” the authors wrote. However, “the interrelationship between these groups of factors is not well understood and needs further investigation.”