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P555 Systematic review of interventions for chronic abdominal pain management in inflammatory bowel disease

Norton C.1, Czuber-Dochan W.2, Artom M.2, Sweeney L.*2, Hart A.3

1King's College, Faculty of Nursing and Midwifery, London, United Kingdom 2King's College London, Faculty of Nursing and Midwifery, London, United Kingdom 3St Marks Hospital, Gastroentrology, London, United Kingdom

Background

Chronic abdominal pain is frequently reported by adults with inflammatory bowel disease (IBD), even when disease is in remission. Pain is an under-recognised and under-treated symptom. This paper will systematically review evidence on interventions for chronic abdominal pain management in patients with IBD.

Methods

Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus and Cochrane Library) were searched (February 2016). Two researchers independently screened the retrieved references and extracted data.

Results

Fourteen papers were included: 12 intervention studies and two cross-sectional surveys. A range of pharmacological, non-pharmacological and dietary supplement interventions were tested. Reduction of abdominal pain was reported for: psychologist-lead stress management (p<0.05) and self-directed stress management (p<0.05), interventions with guided relaxation for both groups; relaxation in groups or individually (pain less intensive p<0.002, less frequent p<0.04, greater pain relief p<0.001 and less pain distress p<0.001). Cognitive behavioural therapy focusing on disease-related concerns also showed pain reduction. Provocative dietary supplements resulted in more pain from alcohol with high sugar content compared to ethanol (p<0.05); there was no difference in pain induced by processed and unprocessed cereals. Current and past cannabis users reported less pain with cannabis use. These results need to be treated with caution, as data were derived from predominantly small uncontrolled studies of moderate to low quality.

Conclusion

Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising approaches, possibly with some individualised dietary changes. There is a need to develop and test interventions for abdominal pain management in IBD.