Characterizing abdominal pain in IBS: guidance for study inclusion criteria,outcome measurement and clinical practice |
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| Authors: | B M R Spiegel R Bolus L A Harris S Lucak W D Chey G Sayuk E Esrailian A Lembo H Karsan K Tillisch J Talley L Chang |
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| Institution: | 1. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA.;2. David Geffen School of Medicine at UCLA, Los Angeles, CA.;3. UCLA Center for Neurobiology of Stress, Los Angeles, CA.;4. UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA.;5. Division of Gastroenterology & Hepatology, Mayo Clinic, Scottsdale.;6. Department of Gastroenterology, Columbia University, New York, NY.;7. University of Michigan Health System, Ann Arbor, MI.;8. Department of Gastroenterology, Washington University, St. Louis, Missouri.;9. Division of Gastroenterology, Harvard Beth Israel Deaconess Medical Center, Boston, MA.;10. Atlanta Gastroenterology Associates, Atlanta, Georgia. |
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| Abstract: | Aliment Pharmacol Ther 2010; 32: 1192–1202 Summary Background Although irritable bowel syndrome (IBS) is a multisymptom disorder, abdominal pain drives illness severity more than other symptoms. Despite consensus that IBS trials should measure pain to define study entry and determine efficacy, the optimal method of measuring pain remains uncertain. Aim To determine whether combining information from multiple pain dimensions may capture the IBS illness experience more effectively than the approach of measuring ‘pain predominance’ or pain intensity alone. Methods Irritable bowel syndrome patients rated dimensions of pain, including intensity, frequency, constancy, predominance, predictability, duration, speed of onset and relationship to bowel movements. We evaluated the impact of each dimension on illness severity using multivariable regression techniques. Results Among the pain dimensions, intensity, frequency, constancy and predictability were strongly and independently associated with illness severity; the other dimensions had weaker associations. The clinical definition of ‘pain predominance’, in which patients define pain as their most bothersome symptom, was insufficient to categorize patients by illness severity. Conclusions Irritable bowel disease pain is multifaceted; some pain dimensions drive illness more than others. IBS trials should measure various pain dimensions, including intensity, constancy, frequency and predictability; this may improve upon the customary use of measuring pain as a unidimensional symptom in IBS. |
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