P617 Analysis of Patient Perception of Pain and Management Strategies in IBD
M. Boyle*1, S. Murphy2, J. Leyden2, P. MacMathuna2, G. Doherty1, G. Cullen1
1St Vincents University Hospital, Gastroenterology, Dublin, Ireland, 2Mater Misercordiae University Hospital, Gastroenterology, Dublin , Ireland
Pain is a common reason for poor quality of life (QOL) in inflammatory bowel disease (IBD) patients. Inflammation, mechanical obstruction, functional impairment, psychological and psychosocial factors influence patient perception of pain. The objective of this study was to establish the prevalence of and factors associated with pain in IBD patients and how they perceive and manage their pain.
A cross-sectional study of consecutive patients with IBD attending out-patient review at two academic centres. A 127 item anonymous questionnaire was distributed to 253 patients and complete responses were obtained in 200 (79%). Physician assessment of disease activity based on recording of biochemical, endoscopic, histologic and radiological parameters was performed, blinded to patient responses. Physicians recorded their opinion on whether pain related to stricture, inflammation, prior surgery/adhesions and/or functional disorder. The validated SAD-21 score, brief pain inventory and CCKnow questionnaires were used to assess stress, anxiety, depression, pain frequency and intensity, and knowledge of IBD. 39 questions related to pain management methods and patient beliefs regarding pain. Data was analysed using SPSS.
Data were collected from 200 patients (mean age 41 years; 55% male; 43% UC, 53% CD, 4% IBDU). Medications: steroids 9%, 5-ASA 43%, biologic 23%, azathioprine 43%. 35% had previous surgery, 22% smoked, 54% in current employment, 46% had third level education. 58% felt well and 64% reported no abdominal pain. 30% had CRP elevation, 61% had endoscopic activity, 34% had radiological activity , 61% had histological activity. Overall 64/200 (32%) of respondents reported pain with average intensity of 3/10 or greater ('pain reporters'). Compared to those without pain, these patients showed no difference in age, disease duration or diagnosis, but more were female (58% versus 40%, p=0.02). Pain reporting was not associated with physician rating of active disease or raised inflammatory markers. Trends to pain reporting were noted in patients with radiological activity (p=0.07), stricture (p=0.08) and with functional bowel disease (p=0.06). The mean scores in the SAD-21 for anxiety (mean = 4.6 versus 1.9, p<0.001), depression (mean = 5.6 versus 2.6, p<0.001) and stress (mean = 7.0 versus 4.1, p<0.001) were significantly greater in pain reporters. 37% of patients reported pain relief interventions in the previous week. Alcohol was second only to paracetamol as the most commonly used pain relief intervention.
Pain is a common symptom in IBD patients and is associated with significantly increased stress, anxiety and depression and may be associated with problem alcohol use.