Mechanisms of chronic abdominal pain in inflammatory bowel disease and implications for treatment

Chronic abdominal pain is prevalent among individuals with inflammatory bowel disease (IBD). Substantial progress has been made in the past few decades in understanding how pain signals travel from the gut to the brain. Preclinical studies have greatly contributed to uncovering the mechanisms of chronic pain in IBD. However, practical applications in clinical settings are still lacking. In this Review, we present the current understanding of the pathological mechanisms of chronic pain in IBD. We explore the neuroplastic changes that occur along the afferent pain pathway from the nerve endings in the colonic mucosa to the brain. We explore the importance of new variables in chronic IBD pain, including the influence of host-microbe interactions during disease, and the effect of comorbid psychological factors, including stress and anxiety, in triggering pain. Finally, we discuss gaps in treatment strategies while proposing new directions for research to identify novel priorities that could pave the way for effective pain therapies.