Why treating chronic pain in gut disease is a matter for your brain

I am a final year PhD student at King’s College London examining pain management for people with Inflammatory Bowel Disease (IBD). The condition is one of the more severe forms of gut disease and can cause debilitating discomfort for those affected. Medication is available but unfortunately, patients often require much more.

When suffering from IBD a patient’s bowel will inflame in cycles. This inflammation can be treated with drugs but when the inflammation subsides, the pain can remain for some individuals, which medical science is not able to fully explain. In essence, the subject of my PhD examines the continuum between IBD as a disease and IBD as symptoms.

So if the symptom of pain persists after the disease has been treated with medication, what can we do? We look to treat the difficulties associated with that pain. Your mind has the ability to substantially amplify the levels of pain that you experience. This is because emotions and pain are both processed in the same part of the brain. Looking at the gut specifically, your brain and gut are closely connected via the vagus nerve, meaning how you’re feeling will undoubtedly affect your gut health. Depression, anxiety, lack of activity and social withdrawal are all examples of psychological processes that exacerbate pain and are often linked with IBD.

Pain is, after all, an inherently emotional experience. Therefore when treating chronic pain in IBD patients we need to treat their mental health. By creating pain management programmes using Cognitive Behavioural Therapy, patients are able to develop techniques to manage their emotions and, in turn, their pain. This may include staying active (despite suffering from pain), maintaining a regular sleeping pattern and self-identifying achievable goals for day-to-day life. This approach to treating chronic pain is not only for patients of IBD, pain management programmes have also been designed for those suffering with illnesses such as HIV or Multiple Sclerosis.

However, whilst we have known about the link between emotion and pain since the 1960s, and have been using non-pharmacological treatments for decades, chronic pain remains to be a severe strain on the lives of many. This is due to various factors.

Firstly, chronic pain is incredibly complex. It can be linked to multiple diseases, varies wildly from person to person and is dependent on a whole host of factors - no one can ever experience another person’s pain. This means that it is challenging to create a pain management programme that is appropriate for many.

Secondly, whilst individual therapy can be more effective, mental health resources are becoming increasingly stretched. The desirable level of support is not always available.

Thirdly, patients respond differently to this approach. Whilst some welcome a non-pharmacological solution as they are tired of the side effects of different drugs, others would prefer a more something more timely. Some people find it unhelpful to be advised to take steps such as regulating their sleeping pattern when their pain is what’s keeping them awake. This causes patients to become trapped in vicious circles, as their pain prevents them from altering their behaviour which could alleviate some of their pain. PhDs like mine heavily involve patients in the creation of the pain management programme, but you cannot guarantee something that will suit everyone.

That being said, these challenges are not cause for despondency. Whilst there is still much we don’t know about chronic pain, we do know that it can be managed and psychological therapy has a large role to play in that. Healthcare resources are indeed limited, but pain management programmes are being designed to allow patients to become their own healthcare provider. Online interventions and eHealth are growing massively and will be crucial in the future treatments of chronic pain. As we improve further, patients will become more responsive to the approach and we can hopefully turn vicious circles into virtuous ones.

Speaking more generally, the more accessible and personalised we can make therapy and self-care, the better chance we have in tackling chronic pain in gut disease.