Pain Management for IBD Patients

Patient and doctor looking at a clipboard together

If you are experiencing pain from your disease and have been able to identify the source of the pain, talk to your healthcare provider(s) about what treatments or therapies might work best for you. Different approaches include traditional medications, psychosocial therapies, and complementary therapies.


Some medications may help relieve your IBD-related pain. Always consult your physician before starting medication; they will help you determine which medications, if any, fit best with your individual treatment plan.



You may wonder why antidepressants can help with pain in IBD if you are not feeling depressed. The short answer is these medications work on certain chemicals in the body that not only exist in the brain but also in the gut. The most common of those chemicals is serotonin. Multiple research studies have found that certain antidepressants are effective treatments for irritable bowel syndrome (IBS), including selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs), and tricyclic antidepressants. More recent studies have found that these medications can also help pain from IBD. Recent research suggests around 37% of IBD patients take antidepressants for pain management.

SSRIs and SNRIs target neurotransmitters, which are used by the body to relay signals along the nervous system to different parts of the body, and within the brain itself. Increasing serotonin and noradrenaline in the brain can help reduce symptoms of depression and anxiety, which can, in turn, reduce pain perceptions. Because the gut hold 95% of the body’s serotonin, these medications also act on the nerves that line the digestive system. While it is not entirely clear yet how SSRIs and SNRIs may affect the gut, we do know they can help decrease abdominal pain and visceral hypersensitivity.

Tricyclic antidepressants (TCA), in low doses, have also been studied to help with the severity of pain in patients with IBD. They work in a similar way as SSRIs and SNRIs; however, there are sometimes significant side effects with these medications such as dry mouth, constipation, blurred vision, urinary retention, and confusion. Additionally, patients on TCAs can experience nervous system side effects such as orthostatic hypotension (blood pressure falls when you stand up), sweating, heart palpitations (feeling that heart is pounding or racing), tachycardia (rapid heartbeat), and increased blood pressure.

Any antidepressant medication can cause physical dependence after a few weeks of use. If you are prescribed an antidepressant, it is important to talk to your doctor about what the process will be should you decide to stop taking it as sudden withdrawal of these medications can lead to rebound pain, depression, and anxiety1,2,3,4 


Antispasmodics are fast-acting medications that relieve spasms in the bowels caused by inflammation, partial bowel obstructions, or excess amounts of gas in the intestines. Research has found antispasmodics to be effective for recurring abdominal pain. However, potential side effects include dry mouth, urine retention, blurred vision, tachycardia (an abnormally rapid heart rate), and drowsiness.

Anti-Inflammatory Drugs/Steroids

Corticosteroids suppress the entire immune response, rather than targeting specific parts of the immune system that cause inflammation. If your pain is driven by the presence of inflammation, then these types of therapies can be effective. However, they have significant short and long-term side effects and should not be used as a maintenance medication. Click here for more information on corticosteroids.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Although NSAIDS (ex: aspirin, ibuprofen, naproxen) can be very effective for non-gastrointestinal pain, it is recommended to avoid these medications with respect to IBD pain. They frequently cause damage to the GI tract and may mimic IBD symptoms. If you are experiencing joint pain, it’s important to talk to your provider about alternate medications that might be more effective.

Opioids (narcotics)

Opioids (also referred to as narcotics) are strong prescription pain relievers traditionally used to relieve acute pain after surgery. Opioids work by attaching to opioid receptors in the central nervous system, which is made up of the brain and spinal cord. Think of receptors like a lock on your door – only one type of key can unlock the door, and the key here is the opioid which can be created naturally by the body or added to the body through medication. When the opioid key meets the receptor lock, the body releases chemicals that reduce pain and provide the person relief. As a rule, long-term use of opioids is not recommended as first-line pain management for patients with IBD. 

Unfortunately, opioids can have many serious side effects, including infections or even death. Opioids can also cause digestive issues including nausea, vomiting, and constipation. Another serious side effect is narcotic bowel syndrome, which can cause chronic or recurring abdominal pain and constipation due to the impact opioids have on the colon. There is also a risk of developing psychological (emotional or mental) and physical dependence on the medications from chronic opioid use. 

Many patients face the difficult choice of pain control versus these other risks. In recent years, public disapproval or stigmatization toward people using opioids has increased significantly.  State and federal regulations (rules) are making it more difficult to use opioids for chronic pain in response to the opioid epidemic (rapid spread).  While opioids can be very helpful in managing chronic pain, the risks should be discussed thoroughly with your doctor. 

Seeking help from a mental health professional 

Woman talking in group therapy circle

Meeting with a therapist can help you to improve your mental health and to feel more in control of your symptoms, such as pain. It is normal to feel stress, anxiety, or depression when living with IBD. Unfortunately, these can contribute to increased inflammation and worsened symptoms in some people. Your mind and gut are intricately interconnected through the brain-gut axis, making our emotional state and how our gut is functioning related. The simplest way to describe this relationship is when you feel butterflies in your stomach when you’re nervous or excited. When the gut is experiencing pain, these same pathways that cause butterflies can amplify pain. Meeting with a psychologist, social worker, or other therapist who understands mind-body treatments can be very helpful for alleviating IBD-related pain.

Two therapies commonly used to treat pain are Cognitive Behavioral Therapy and Gut Directed Hypnotherapy. Click here for more information on psychosocial therapies.

Complementary therapies for IBD

Senior woman meditating on yoga mat indoors

Some studies have shown that complementary medicine may help to control IBD symptoms, ease pain, contribute to a better quality of life, and improve your mood and general attitude towards your health and well-being. Below are a few examples of therapies that have been researched to specifically help with IBD pain. Always check with your provider prior to trying any complementary therapy.

  • Mind-body therapies, which include meditation, mindfulness, yoga, and exercise, have been shown to help improve depression, anxiety, and overall quality of life.
  • Light Exercise and Physical Therapy, specifically pelvic floor muscle training and abdominal manipulation can help alleviate painful symptoms such as fecal incontinence (lack of control of bowel movements), urinary urgency, sarcopenia (muscle failure), fatigue, or pelvic pain.
  • Medical cannabis, in small studies, has improved IBD symptoms including pain, nausea, and decreased appetite. However, there is there is currently no evidence that medical cannabis can reduce IBD inflammation or improve disease activity. Further research is needed, and underway now, regarding the impact of cannabis on IBD. 



1) Cross RK1, Wilson KT, Binion DG, Nacrotic use in patients with Crohn’s disease, American Journal Gastroenterology, 2005 Oct;100(10):2225-9., accessed, July 1, 2019

2) Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol. 2006;4:621–630. [PubMed] [Google Scholar]

3) Waseem Ahmed, MD and Seymour Katz, MD, Therepeutic Use of Cannabs in Inflammatory Bowel Disease, Gastroentoerogy & Hepatogoy, 2016 Nov; 12 (11): 668-679, accessed, July 1, 2019

4) Docherty M, Jones R, and Wallace M. Managing Pain in Inflammatory Bowel Disease. Gastroenterol Hepatol (NY) 2011 Sept; 7(9):592-601.