title: Chronic pain in inflammatory bowel disease: characteristics and associations of a hospital-based cohort.
abstract: BACKGROUND
  Chronic pain (CP) is a common symptom in patients with inflammatory bowel disease. This study aimed to examine its prevalence, severity, clinical associations, and impact on psychological well-being and to identify patient factors that independently predict the presence of severe/disabling pain.
  
  
  METHODS
  One hundred and twenty consecutive patients with inflammatory bowel disease attending a hospital-based clinic provided information through questionnaires on quality of life, mood disturbance, and functional gut symptoms. Those who had CP (pain occurring every day for 3 months within the past 6 months) provided additional information on the pain's intensity and associated disability and management and coping strategies.
  
  
  RESULTS
  Forty-six patients (38%) had CP, most commonly in the abdomen (91%), and they had higher disease activity, reduced quality of life, and more depression and anxiety and took more paracetamol and opiates than those without. These indices were worse in the subgroup of 23 with moderate-severe pain/disability. Criteria for irritable bowel syndrome were met in 70% of those with pain irrespective of its severity. Multivariate analysis identified 4 independent associations with moderate-severe pain/disability: active disease (odds ratio, 49 [95% confidence intervals, 1.6-1455]), catastrophizing tendency (35 [3-228]), medication belief score (0.05 [0.005-0.55], and depression score (1.80 [1.02-3.17]).
  
  
  CONCLUSIONS
  CP has major effects on quality of life and functional and social outcomes. Active disease and maladaptive coping strategies and negative attitudes and beliefs toward symptoms are independently associated with more severe pain. Management strategies should move the focus away from analgesic dependence toward psychosocial intervention and nonpharmacologic therapy.
authors.affiliation: Eastern Health Clinical School, Eastern Health, Monash University, Melbourne, Australia. grahammorrison@doctors.org.uk
authors.forename: Graham
authors.initials: G
authors.lastname: Morrison
authors.forename: D R
authors.initials: DR
authors.lastname: Van Langenberg
authors.forename: S J
authors.initials: SJ
authors.lastname: Gibson
authors.forename: P R
authors.initials: PR
authors.lastname: Gibson
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001007:Anxiety / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D003430:Cross-Sectional Studies; D003469:Culture; D003863:Depression / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid