ECCO'25: Y-ECCO/ClinCom Survey - Management of Pain in Inflammatory Bowel Disease


Background Pain is a prevalent symptom of inflammatory bowel disease (IBD) that significantly impacts quality of life (1, 2). Effective pain management is important and typically involves both disease control and using pain relief medications such as paracetamol, non-steroidal anti-inflammatory drugs (NSAID) - including COX-2 inhibitors - and opioids. NSAIDs are recognised as one of the most effective pain relief medications. However, NSAIDs have traditionally been avoided in IBD due to risks of gastrointestinal injury and potential IBD flares (3-5). Recent findings suggest that there may not be a strong association between NSAID use and IBD flares, which contradicts previous beliefs (6, 7). Updated ECCO Guidelines recommend considering NSAIDs on a case-by-case basis (8). Despite this new guidance, many IBD patients may still be advised against using NSAIDs, resulting in inadequate pain relief compared to non-IBD patients. Functional pain, being one of the most common types of pain in IBD, is typically managed with treatments such as SNRIs and nonmedical interventions. In contrast, traditional pain management for other forms of pain often involves medications such as paracetamol, NSAIDs, and opioids. Therefore, there may be a need for a shift in attitudes towards pain relief in IBD. In order to motivate such change and improve pain management in IBD, we need data to define current practices and identify necessary changes for implementation. 

 
Aim To assess physicians’ prescription attitudes towards pain relief medications for IBD patients and determine whether any of these medications are being avoided or preferred, in a way that may be detrimental to IBD patient care. 


Method To have the proposed survey launched online at the ECCO congress in 2025. All prescribers (including residents, specialists, and consultants)  and non-prescribers (nurses and dieticians) who work with IBD patients in any setting (outpatient and inpatient clinics) are welcome to complete the survey. 

 

References 
1.    Algaba A, Guerra I, Ricart E, Iglesias E, Manosa M, Gisbert JP, Guardiola J, et al. Extraintestinal Manifestations in Patients with Inflammatory Bowel Disease: Study Based on the ENEIDA Registry. Dig Dis Sci 2021;66:2014-2023.
2.    Schirbel A, Reichert A, Roll S, Baumgart DC, Buning C, Wittig B, Wiedenmann B, et al. Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World J Gastroenterol 2010;16:3168-3177.
3.    Habib I, Mazulis A, Roginsky G, Ehrenpreis ED. Nonsteroidal anti-inflammatory drugs and inflammatory bowel disease: pathophysiology and clinical associations. Inflamm Bowel Dis 2014;20:2493-2502.
4.    Feagins LA, Cryer BL. Do Non-steroidal Anti-inflammatory Drugs Cause Exacerbations of Inflammatory Bowel Disease? Digestive Diseases and Sciences 2010;55:226-232.
5.    Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS. Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. J Clin Gastroenterol 2016;50:152-156.
6.    Moninuola OO, Milligan W, Lochhead P, Khalili H. Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation. Aliment Pharmacol Ther 2018;47:1428-1439.
7.    Cohen-Mekelburg S, Van T, Wallace B, Berinstein J, Yu XS, Lewis J, Hou J, et al. The Association Between Nonsteroidal Anti-Inflammatory Drug Use and Inflammatory Bowel Disease Exacerbations: A True Association or Residual Bias? American Journal of Gastroenterology 2022;117:1851-1857.
8.    Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024;18:1-37.

Thank you for completing this survey! If you are a prescriber, please answer the following questions according to your usual prescribing practice. If you are not a prescriber, please answer the following questions according to your usual advice to patients and/or the usual prescribing practices in your workplace

As a thank you for your participation, all survey participants are invited to submit their email address for an annual lottery drawing of 3 x ECCO Interaction Tickets for  the ECCO Congress 2026. 

There are 28 questions in this survey.

Questions

1. Have you completed this survey before?  
2. Main field of work
Gastroenterology - IBD
Surgery
Endoscopy
Neurogastroenterology
Other: 
3. Main place of work 
Primary care
Specialized outpatient care
Regional hospital
University Hospital
Other: 
4. Which country do you work in?
5. Current role
Junior doctor
Resident doctor
Specialist doctor
Consultant
Nurse
Dietitian
6. Do you prescribe NSAIDs to IBD patients? 
7. Do you prescribe opioids (all forms of morphine) to IBD patients?

8. Main reason for prescribing opioids

Insufficient effect of paracetamol
Insufficient effect of NSAID
Insufficient effect of the combination paracetamol and NSAID
Avoid NSAID
Patient demand
Tradition at the clinic
Prescription renewal for long-term treatment
Other: 

9. Do you prescribe opioids for IBD patients with abdominal pain?

10. Preferred treatment for long-term abdominal pain in IBD patients (multiple choices possible).

Paracetamol
NSAID
Paracetamol and NSAID
Opioids
Tricyclics
SNRI
SSRI
Non-pharmacological alternatives
Nothing
Other:

11. Preferred treatment for joint pain in IBD patients

Paracetamol
NSAID
Paracetamol and NSAID
Opioids
Sulfasalazine
Non-pharmacological alternatives
Other: 

12. Secondary treatment option for joint pain in IBD patients

Paracetamol
NSAID
Paracetamol and NSAID
Opioids
Sulfasalazine
Non-pharmacological alternatives
Other: 

13. Do you prescribe opioids for joint pain in IBD patients?

14. Are there any medications that you avoid for IBD patients?

Paracetamol
NSAID
Opioids
No
Other: 

15. What is the main reason for avoiding NSAIDs?

Risk of IBD flare
Risk of gastrointestinal bleeding
Risk of kidney injury
No particular reason
Other: 

16. Do you recommend NSAIDs to IBD patients in remission?

17. Do you recommend NSAIDs to IBD patients during a flare?

18. Case 1. What is your preferred pain management choice for a healthy patient without IBD and good renal function experiencing kidney stone pain?

Paracetamol
NSAID (incl. toradol)
Morphine
Nothing
Other: 

19. Case 2. What is your preferred pain management choice for an IBD patient in remission and with good renal function experiencing kidney stone pain?

Paracetamol
NSAID (incl. toradol)
Morphine
Nothing
Other: 
20. Case 3. What is your preferred pain management choice for a healthy patient without IBD and with good renal function experiencing recurrent menstrual pain for 2 days each month?
Paracetamol
NSAID
Paracetamol and NSAID
Opioids
Nothing
Other: 
21. Case 4. What is your preferred pain management choice for an IBD patient in remission and with good renal function experiencing recurrent menstrual pain for 2 days each month?
Paracetamol
NSAID
Paracetamol and NSAID
Opioids
Nothing
Other: 
22. How frequently do you consider non-pharmacological therapies (e.g., physiotherapy, psychological support) for IBD pain management?
Always
Frequently
Sometimes
Never
23. What type of pain do you find most difficult to manage in IBD patients?
Abdominal pain
Joint pain
Extra-intestinal manifestations (e.g., skin, eyes)
Neuropathic pain
Other: 
24. Are you concerned about opioid dependence or misuse in IBD patients when prescribing opioids for pain?
Yes, always
Yes, occasionally
No, not concerned
No, never
25.    Do you believe the management of pain in IBD patients is adequately addressed in current clinical guidelines? 
Yes
No
Not sure
26.    Would you support the development of specific pain management guidelines for IBD patients? 
Yes
No
Not sure

ECCO Interaction: Hearts and Minds

27. Do you want to participate in the ECCO Congress Lottery for a free ticket to the ECCO Interaction: Hearts and Minds at the ECCO'26?
28. Great! Now please enter your name, surname and email address: