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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