AGA Clinical Practices Update: Pain Management in Patients With Disorders of Gut-Brain Interaction

A review of best practices published in the December issue of Clinical Gastroenterology and Hepatology addresses chronic gastrointestinal pain management for patients with disorders of the gut-brain interaction, with a focus on pain that has persisted beyond first-line therapies targeted toward visceral causes.

“AGA Clinical Practices Update: Pain Management in Patients With Disorders of Gut-Brain Interaction,” advises on the patient-provider relationship, nonpharmacologic and pharmacologic therapies, and avoidance of opioids. This was not a formal systemic review, and no ratings of the quality of evidence or strength of recommendation were performed.

The expert review group stressed the importance of a collaborative, empathic, culturally sensitive relationship between patient and providers and of an understanding of the psychological contexts in which pain is perpetuated. Whenever possible, providers should use patient-friendly language about the pathogenesis of pain, and how to leverage advances in neuroscience and behavioral science.

The experts also encourage providers to consider nonpharmacologic therapies routinely as a part of comprehensive pain management. Opioids should not be prescribed for chronic gastrointestinal pain because of a disorder of gut-brain interaction. If a patient is already on opioids at the time of referral, providers should prescribe responsibly, collaboratively, and with the goal of the drug being discontinued.

Noting the difference between gastrointestinal pain triggered by visceral factors versus centrally mediated factors is important, the authors stated. Providers should optimize medical therapies that are known to modulate pain, and be familiar with effective neuromodulators. This requires that practitioners know the dosing, side effects, and targets of each of these therapeutic agents, and be able to explain to the patient why these drugs are used for the management of persistent pain.

—Allison Casey

Reference:

Keefer L, Ko CW, Ford, AC. AGA Clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction: Expert review. Clin Gastroenterol Hepatol. 2021;19(12):P2481-2488.