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Frequency of Functional Pain Overlap in Pediatric Crohn’s Disease

July 1, 2013 7:04 am

If a patient with Crohn’s disease has pain, it may signal a flare-up of the inflammatory process. Other causes like secondary infections, strictures, and functional pain need to be considered as well. Functional pain can be particularly challenging. A recent study reports on the prevalence of functional pain overlap in this setting (Inflamm Bowel Dis 2013; 19: 826-31).

This study prospectively enrolled 307 patients from two centers; it was a substudy to a cognitive behavioral therapy trial.

Patients in remission were defined by the following:

all normal laboratory findings:erythrocyte sedimentation rate <10, albumin >3.5, C-reactive protein <1 mg/dL
absence of clinical signs/symptoms of inflammatory bowel disease: 3 or less stools per day, no bloody stools, no nocturnal stools, no strictures, no concurrent steroid therapy
no escalation in medical therapy or clinical relapse in previous 6 months

Results: 139 of 307 patients had abdominal pain. Among those with pain, 18 (13%) patients had functional abdominal pain (FAP). 10 of the 18 had either a colonoscopy or MRI in the previous year. In these patients, the median PCDAI was 10.

This study noted a higher rate of depression in patients with both FAP and Crohn’s: 56%. This is compared with 29% of Crohn’s patients in remission without pain and 45% of Crohn’s patients with pain due to active disease.

Key points:

Pain with or without active disease can lead to an overestimation of disease activity based on PCDAI.
Depression is common in patients with pain, regardless of etiology
Current diagnostic criteria for FAP are flawed. In fact, the Rome III criteria for FAP which specify absence of organic disease.
Biomarkers and imaging modalities are the best tools to exclude active disease.

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