For people with Crohn’s disease, flares are something everyone hopes to
avoid. According to the Crohn’s & Colitis Foundation of America (CCFA),
symptoms of a Crohn’s flare often include abdominal pain, diarrhea, urgent bowel
movements, loss of appetite, weight loss, and fever.
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Keeping your disease in remission for as long as possible — by taking the
drugs prescribed by your doctor for this purpose — is an important part of
treatment. But even when you take your medications diligently, there’s a
possibility that a number of factors — including stress, certain foods and
drugs, and smoking — may trigger a flare anyway.
As noted in an article published in January 2016 in the World Journal of
Gastroenterology, many flares happen in a random, unpredictable way, with no
known incident or behavior triggering them.
The good news is that there are steps you can take to minimize the pain
associated with flares. Some of these are things you can safely do on your own,
while others require the involvement of your doctor. Not every measure described
here will work for everyone, but each offers a chance for relief from pain and
discomfort.
How to Treat Inflammation From Crohn’s
The single most important thing you can do to relieve pain from a flare is to
see your doctor for treatment, says Joel B. Levine, MD, a gastroenterologist and
professor of medicine at the University of Connecticut. The best strategy, Dr.
Levine says, “is really the opposite [of] the treatment of isolated pain,” but
rather “to look at the nature of the pain.”
Due to where nerves are located, says Levine, inflammation in the intestinal
wall “is very likely to produce pain” in Crohn’s disease. By reducing this
inflammation, pain can be relieved.
To treat the inflammation causing your flare, your doctor may change the dose
of a drug you already take or add a new drug. Drugs used to treat inflammation
include aminosalicylates, corticosteroids, immunosuppressants, and
biologics.
Drugs Can Provide Pain Relief for Crohn’s
Not all doctors agree that treating pain, specifically, from Crohn’s disease
is the right course of action. Levine prefers to focus on the root causes of
pain. “When those are treated effectively, the pain goes away,” he says.
But Robert Carroll, MD, a gastroenterologist and associate professor of
medicine at the University of Illinois College of Medicine at Chicago, believes
that targeted pain relief has a role to play in managing Crohn’s flares. He
often sees patients who were recently discharged from the hospital and are
already on pain medications.
“I think if you completely deny the use of narcotics,” says Carroll, “you end
up undertreating pain.” But he tries to use the least strong narcotics when
possible, often prescribing acetaminophen with codeine. Although, given the
addiction risks of opiates, it’s important to have clear discussions with your
doctor about the potential risks of using opiate medications to manage chronic
pain
Some patients, says Carroll, benefit from using lidocaine patches on certain
parts of their abdomen. He’s “surprised by how effective that can be,” he
says.
Carroll also believes that medical marijuana can be effective in some
patients, especially those with moderate disease. “There’s some evidence that
the cannabinoid receptors are involved in the inflammatory process in IBD
[inflammatory bowel disease],” he says, adding that large trials of cannabis are
needed before it becomes a standard treatment.
Diet Is An Important Part of Treating Crohn’s
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As the CCFA notes, not everyone with Crohn’s experiences diet-related
symptoms. But common dietary causes of discomfort include dairy foods, uncooked
fruits and vegetables, greasy foods, caffeine, alcohol, and carbonated
drinks.
You may benefit from avoiding these foods during a flare, or from keeping a
food journal to see if anything in your diet is related to your symptoms.
As far as taking dietary supplements, Carroll finds that some patients
benefit from probiotics. Taking supplements containing iron, in contrast, can
aggravate symptoms and cause pain, he says. Carroll believes that IV iron
replacement is a better solution to low iron levels in IBD patients that have
iron deficiency and anemia.
Rest and Exercise Can Reduce Crohn’s Pain
Getting enough rest and exercising may seem like opposites, but both are key
to keeping your body in good shape and can help minimize pain, Carroll says.
When it comes to specific exercises for pain relief, Carroll likes Pilates
and yoga. “I think both of those are able to get people to focus on other things
besides abdominal pain.”
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But remember that distracting from your pain — through exercise or other
activities — can only go so far. “I try and emphasize with patients,” says
Carroll, that ultimately, “getting the disease controlled should relieve their
pain.”
