Background & Aims

Pain is a common symptom of inflammatory bowel disease (IBD), impacting 50-70% of youth and adults during active disease, and about 20% of individuals during remission (Bielefeldt et al., 2009; Crandall et al., 2007; Zimmerman et al., 2013). High rates of pain is a concern in this population because it has been linked to poor psychological and physical health consequences in youth with IBD (Greenley et al., 2013). Cross-sectional research indicates that disease severity, optimism, and pain self-efficacy are associated with pain (Ahola Kohut & Keefer, 2023; Cousins et al., 2015; Murphy et al., 2020, 2021) but little is known about the trajectory of pain and its relation with such factors in the context of IBD over time. The aim of this study is to characterize pain intensity (average, worst) in youth with inflammatory bowel disease up to 12-months post-diagnosis, and to examine its relation with risk (disease severity) and resilience (optimism, pain self-efficacy) factors over time.

Methods

Newly diagnosed youth aged 8-16 with IBD completed numerical rating scales for average and worst pain intensity, Youth Life Orientation Test for optimism, and Pain Self-Efficacy Scale for pain self-efficacy; weighted PCDAI for Crohn’s disease and the PUCAI for ulcerative colitis were completed. Descriptive statistics characterized pain. Multilevel modelling explored relation between variables over time, including moderation effects of optimism and self-efficacy.

Results

At baseline, 74 youth (Mage = 13.5, SD = 2.5; 63.5% Crohn’s disease; 43.2% female) were included. Attrition rates at 4 and 12 months were 2.70% and 6.76%, respectively. Across time, a minimum of 42% of the participants reported pain. Higher disease severity predicted higher average and worst pain, regardless of time since diagnosis. Higher pain self-efficacy: a) predicted lower average and worst pain, especially at later time points; and b) attenuated the association between disease severity and both average and worst pain when included as a moderator. Higher optimism predicted lower worst pain regardless of time.

Conclusions

Pain is prevalent in pediatric IBD and can be impacted by disease severity, pain self-efficacy, and optimism. Higher disease severity is a risk factor for higher pain, and both pain self-efficacy and optimism are resilience factors. The relationship between pain and pain self-efficacy may be time-dependent, whereas the relation with disease severity and optimism does not seem to vary with time.

References

Ahola Kohut, S., & Keefer, L. (2023). Building a Self-Management Toolkit for Patients with Pediatric Inflammatory Bowel Disease: Introducing the resilience 5. Gastroenterology Clinics of North America, 52(3), 599–608. https://doi.org/10.1016/j.gtc.2023.05.005

Bielefeldt, K., Davis, B., & Binion, D. G. (2009). Pain and Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 15(5), 778–788. https://doi.org/10.1002/ibd.20848
Cousins, L. A., Kalapurakkel, S., Cohen, L. L., & Simons, L. E. (2015). Topical Review: Resilience Resources and Mechanisms in Pediatric Chronic Pain. Journal of Pediatric Psychology, 40(9), 840–845. https://doi.org/10.1093/jpepsy/jsv037

Crandall, W. V., Halterman, T. E., & Mackner, L. M. (2007). Anxiety and Pain Symptoms in Children With Inflammatory Bowel Disease and Functional Gastrointestinal Disorders Undergoing Colonoscopy. Journal of Pediatric Gastroenterology and Nutrition, 44(1), 63. https://doi.org/10.1097/01.mpg.0000239733.79487.1e

Greenley, R. N., Kunz, J. H., Schurman, J. V., & Swanson, E. (2013). Abdominal Pain and Health Related Quality of Life in Pediatric Inflammatory Bowel Disease. Journal of Pediatric Psychology, 38(1), 63–71. https://doi.org/10.1093/jpepsy/jss097

Murphy, L. K., de la Vega, R., Kohut, S. A., Kawamura, J. S., Levy, R. L., & Palermo, T. M. (2021). Systematic Review: Psychosocial Correlates of Pain in Pediatric Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 27(5), 697–710. https://doi.org/10.1093/ibd/izaa115

Murphy, L. K., Suskind, D. L., Qu, P., Zhou, C., Gashi, K., Kawamura, J. S., Palermo, T. M., & for the ImproveCareNow Pediatric IBD Learning Health System, as stipulated by I. (2020). Abdominal Pain After Pediatric Inflammatory Bowel Disease Diagnosis: Results From the ImproveCareNow Network. Journal of Pediatric Gastroenterology and Nutrition, 71(6), 749. https://doi.org/10.1097/MPG.0000000000002933

Zimmerman, L. A., Srinath, A. I., Goyal, A., Bousvaros, A., Ducharme, P., Szigethy, E., & Nurko, S. (2013). The Overlap of Functional Abdominal Pain in Pediatric Crohn’s Disease: Inflammatory Bowel Diseases, 19(4), 826–831. https://doi.org/10.1097/MIB.0b013e3182802a0a

Presenting Author

Natisha Nabbijohn

Poster Authors

Natisha Nabbijohn

MA

University of Guelph

Lead Author

David Mack

MD

Children’s Hospital of Eastern Ontario

Lead Author

Alain Stintzi

PhD

University of Ottawa

Lead Author

Meghan McMurtry

University of Guelph; McMaster Children’s Hospital

Lead Author

Topics

  • Mechanisms: Psychosocial and Biopsychosocial