Many people with inflammatory bowel disease (IBD) feel abdominal pain even when they are not having a flare-up.
A new study from Ruhr University Bochum in Germany suggests that this pain may be linked to how the brain processes fear and pain.
The researchers say that this connection could help us understand why pain continues even when inflammation is under control, and it may lead to better treatments.
IBD includes conditions like ulcerative colitis and Crohn’s disease. These diseases cause inflammation in the digestive system. During flare-ups, symptoms like pain and diarrhea are common.
But some patients continue to feel pain even during remission, when inflammation is low. This has puzzled doctors and scientists for a long time.
Dr. Hanna Ohlmann, one of the lead researchers, says that fear may play a role. Pain in the belly often warns us about possible harm, so we quickly learn to fear anything that happens just before the pain starts.
Normally, this fear helps us avoid danger. But in chronic conditions, the fear response can become too strong and may make the pain feel worse.
To study this, the researchers tested 43 people. Twenty-one had ulcerative colitis, and the rest were healthy. On the first day of the study, the participants looked at different symbols on a screen.
One symbol was followed by a painful heat on the lower belly. Another symbol was not. Over time, participants learned to associate the painful symbol with discomfort.
Later, all symbols were shown again without pain, helping to reduce the fear. On the second day, the same process was repeated, but then the researchers suddenly applied painful heat again without any warning. This helped the researchers see how people responded when pain returned unexpectedly.
The results were interesting. People with IBD said the pain felt more unpleasant and stronger than what healthy people felt.
This reaction was connected to how much fear they had learned on the first day—but only for the IBD group. The emotional part of pain, how bad it feels, was influenced more by fear than the physical strength of the pain itself.
This means the way people with IBD connect fear and pain is different. They don’t necessarily learn fear more strongly than others, but fear affects how they feel pain more deeply. Over time, repeated inflammation might change how the brain reacts to pain and fear.
Other research has already shown that IBD patients may have changes in brain areas that handle pain and fear. These changes could help explain why the pain sticks around even when there’s no active inflammation.
Right now, treatments for IBD mostly try to stop inflammation. But this study suggests that mental and emotional health matters too. Fear, stress, and avoiding certain situations might make pain worse.
So, treating chronic pain in IBD may need more than just medicine. It could help to include psychological support, like cognitive behavioral therapy, which helps people understand and manage their fears.
Dr. Ohlmann says that chronic belly pain should be seen as a real and important part of IBD. If someone still has pain even though their gut looks healthy, they might need extra support for their mental health. This kind of care could also help people with other painful diseases like arthritis or endometriosis.
If you care about gut health, please read studies about how probiotics can protect gut health ,and Mycoprotein in diet may reduce risk of bowel cancer and improve gut health.
For more health information, please see recent studies about how food additives could affect gut health, and the best foods for gut health.
This study was published in the journal Pain and opens the door for new ways to help people who live with chronic illness and ongoing pain.
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