Physical Risk Factors of Pain

There are many factors that can cause or worsen pain in IBD. 


The most common cause of pain when you have IBD is a disease flare resulting in inflammation of your GI tract. During inflammation, chemicals are released called inflammatory mediators. These play an important role in the inflammatory process and can make the neurons in the GI tract very sensitive to pain.

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Sensitization of the Central Nervous System (CNS)

Sometimes, even when the inflammation is gone, your CNS is still highly sensitive to pain signals. This is called central sensitization of the CNS. It can contribute to your pain.

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Other conditions and diseases

The presence of other diseases (comorbid conditions), such as inflammatory arthritis, can increase your risk for chronic pain. This heightened risk may occur directly, from increased pain signals being sent to the CNS. It can also occur indirectly, when stress accumulates from different conditions, leading to more pain.

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Drug-induced pain

Sometimes the medications you take can cause pain. For example: 

  • Aminosalicylates, such as mesalamine, can cause abdominal pain

  • Biologics can cause joint pain

  • Enteral iron (oral iron replacement), which is commonly used to treat anemia, can cause abdominal pain

While opioids are used in some patients to treat pain, the chronic use of opioids has been linked to complications in Crohn’s disease activity and severity, increased risk for surgical interventions, and opioid misuse. In addition, opioid use can lead to narcotic bowel syndrome, which causes chronic or frequent abdominal pain.

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Gut motility and IBD

Motility is the movement of food through your intestines. Motility problems in your small intestine can slow contractions. This can result in inflammation and pain. Also, sometimes stress can alter motility, resulting in pain.

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Imbalance of the gut microbiome (microbiota)

The microbiota is the community of microorganisms that live in your gut. Patients with IBD tend to have a decrease in the population, diversity, and stability of their microbiota. This imbalance leads to inflammation and pain.

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Small Intestinal Bacterial Overgrowth (SIBO)

Small intestinal bacterial overgrowth (SIBO) is when there is too much bacteria in the small intestine. It is caused by decreased gastric acid secretion and problems with the movement of food through your intestines (motility). SIBO can cause abdominal pain.

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Sleep Problems

Sleep complaints are present in 67% to 88% of chronic pain disorders. At least half of people with insomnia suffer from chronic pain. The development of pain tends to go hand in hand with the development of sleep disturbance.

Visit our Sleep Problems section for strategies to improve sleep quality. 

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Approximately 20% of patients with ulcerative colitis, and up to 80% of Crohn’s disease patients will need surgery during their lifetime. Surgery can cause pain for a limited time. If you develop scar tissue after surgery (adhesions), these can cause longer-lasting pain.

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Visceral Hypersensitivity

Visceral hypersensitivity is an increased sensitivity of your internal organs as a result of persistent inflammation. Visceral hypersensitivity causes more intense pain in your internal organs, which can lead to lower threshold for pain when compared to what others might experience. 

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Genetics might also be a factor. Sometimes pain conditions can ‘run in families’ but this is a challenging area of study. 

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