Crohn’s & Colitis UK’s pain targeted call

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This call is focused on the common symptom of pain experienced by people with inflammatory bowel disease: its causes, patterns, impact, prognosis and treatment.

The call aims to promote our understanding of what is unique about pain in people with IBD and what is shared with other people who have persistent pain, in order to identify best practice for prevention and management of this troublesome problem and to improve quality of life in people with IBD.

The four areas below offer a broad guide to topics that could be addressed by proposals responding to this call.

Theme 1: Mechanisms of pain in patients with IBD

Acute and chronic pain are common features of daily life for patients with IBD. This theme calls for research projects that seek to further our understanding of the pathogenesis of pain in patients with IBD and where it comes from (including molecular, microbiomic, neural, inflammatory, psychological, social mechanisms). In particular there is a need to define and investigate (a) pain that is unique to the patient experience and pathology of IBD itself (e.g. pain from visceral nociception), (b) pain linked to central nervous system processing which may be common across all chronic pain conditions regardless of underlying disease, and (c) the links between other bodily pains, symptoms and morbidities and IBD pain.

Theme 2: The epidemiology, classification and assessment of pain in patients with IBD

This theme seeks to expand our knowledge and understanding of the occurrence, patterns and impact of pain in patients with IBD, and to promote research that identifies predictors (including genetic, biomarker, disease activity, clinical, psychological, social and treatment factors) of poor pain outcomes in IBD patients (including work loss and opioid dependence) as the basis for stratified or targeted interventions.

Proposals in this theme might also include new research or reviews seeking to adapt or develop pain classifications and outcome measures which can be included widely in studies and clinical settings, and (a) be compared across patients with IBD, distinguishing between UC and Crohn’s disease phenotypes (b) be used to investigate associations with IBS pain and with other symptoms such as depression and fatigue, and (c) be compared with other chronic disease patient groups where pain is also problematic.

Longitudinal studies and those which use established existing large cohorts (e.g. the IBD BioresourceALSPAC, UK BiobankEPIC) are likely to take priority under this theme.

Theme 3: Improving treatment for patients with IBD who have pain

This theme seeks proposals which may represent (a) novel approaches to pain management in IBD patients e.g. pharmacological / non-pharmacological / alternative/complementary health strategies, or (b) the investigation and application of established evidence-based pain management interventions (for other chronic pain conditions) to patients with IBD.

Early phase and proof-of-principle studies, pilot efficacy or effectiveness trials, and implementation studies might all be appropriate for this theme. Projects under this theme might also address the benefits and harms of analgesic use (including opioids) in this patient group, and the evidence about long-term treatment effectiveness.

Theme 4: The experience of patients with IBD who have pain

Although proposals under all four themes will be expected to have strong patient and public engagement, this theme is focused specifically on giving voice to the patient experience in order to (a) explore the nature of pain in this patient group and what pain means for patients, including its short and long-term impact on their lives, and (b) to investigate the support and outcomes that patients want and their understanding of chronic pain and its management and their perceptions of its treatment.

Projects under this theme might investigate the availability of health care resources for patients with IBD, and barriers and enhancers of pain management in this group. Qualitative studies and health services research will be considered under this theme, including proposals linked to established cohorts.