Dr Keefer, a GI psychologist, discusses the importance of viewing all abdominal pain among patients with inflammatory bowel disease as "IBD pain" and provides guidance in methods for managing such pain.

Laurie Keefer, PhD, is an academic health psychologist and the director for Psychobehavioral Research within the Division of Gastroenterology at the Icahn School of Medicine at Mt Sinai in New York City.

TRANSCRIPT:

Laurie Keefer:

Hi, I'm Dr. Laurie Keefer. I'm a professor of medicine and psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. I'm a gastro psychologist by training, which means that I apply behavioral principles to gastrointestinal conditions. I'm here at ACG in beautiful Vancouver and I just finished a presentation on non-IBD pain.

Here are a couple key talking points. One, I don't think it's fair to say that pain is non-IBD. I think all of us should be thinking of our patients holistically and that their abdominal pain may not be related to active inflammation but is still part of their overall inflammatory bowel disease picture. With that, as a IBD doctor or an IBD advanced practice provider, you will want to continue to treat your patient's abdominal pain as if it was part of your overall GI care plan. Just like IBD is waxing and waning, so is abdominal pain.

The other key talking point was the role of the multidisciplinary team, which is sometimes hard to do, but really recognizing that it takes a village to manage chronic pain, whatever the cause, whether it's related to a surgical incision, whether it's related to an overarching inflammatory condition or whether it's centrally mediated such as what we see in irritable bowel syndrome or centrally mediated abdominal pain syndrome. And by multidisciplinary, that means a really strong doctor-patient relationship where you can really communicate with the patient the reason for addressing pain in the setting of their IBD. I think it's important that you don't focus so much on the cause of the pain, recognizing that it's multifactorial, which is again why you're asking the multidisciplinary team to get involved.

Now, as a psychologist, there are several brain gut behavior therapies that can be applied to chronic pain in IBD including cognitive behavior therapy and gut directed hypnotherapy, and we talked a lot about that today. The other part we talked about was the role of opioids and the importance of discontinuing them in any pain that is over three months, these have adverse consequences for pain, can actually increase pain, and also increase susceptibility to things like infection and need for surgery and other complications. Alternatives to opioids could include central neuromodulators such as tricyclic antidepressants or SSRIs. It could include gabapentin or other types of pain medication geared at, again, that central nervous system. It could even include, we talked a little bit about this controversially, of the use of cannabis as an alternative to opioids, although the evidence here is not very strong.

So overall, the main take home point here was that IBD pain is always IBD pain and that the role of the IBD doctor is to understand where pain comes from and how to manage it without the use of opioids.