Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
Florence Nightingale School of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
BMJ Open Gastroenterol. 2024 Oct 29;11(1):e001540. doi: 10.1136/bmjgast-2024-001540.
Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain.
In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups.
Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain).
The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.
炎症性肠病（IBD）患者的疼痛经常被忽视，尤其是溃疡性结肠炎患者，且医患之间的疼痛沟通可能并不理想。本研究将临床医生对患者疼痛的概念与患者的叙述进行对比。目的是为疼痛报告工具的开发提供信息，并为更好地沟通 IBD 疼痛提供指导。
在英国对 13 名 IBD 临床医生进行深入的半结构化访谈：胃肠病学家（n=5）、结直肠外科医生（n=2）、专科护士（n=4）和心理学家（n=2）。对这些数据进行主要分析，并对之前关于 IBD 疼痛的访谈进行二次分析，访谈对象包括临床医生（n=12）和患者（n=71），采用反思性主题分析的原则。对不同组别的主题进行比较。
临床医生表示，他们经常询问克罗恩病患者的疼痛情况，但不询问溃疡性结肠炎患者的疼痛情况。然而，患者报告称在这两种疾病中都存在对疼痛关注不一致的情况，权力动态限制了他们的疼痛报告。一些临床医生承认，他们假设患者可以独立管理自己的疼痛，从而导致随访不足（主题 1：在讨论 IBD 疼痛时存在矛盾和模糊）。临床医生对疼痛的不充分承认归因于时间限制和系统性问题。在缺乏炎症或结构原因的情况下，一些临床医生默认将疼痛归因于肠易激综合征，导致患者感到不被关心（主题 2：疼痛工具和时间有限的后果）。一些患者不愿意表达不适或疼痛，而另一些患者则避免可能导致疼痛的活动，这使得解决疼痛问题变得更加复杂（主题 3：处理不抱怨疼痛的患者）。
该研究强调了对疼痛进行一致评估和管理的重要性，倡导临床医生和患者之间进行更开放的对话。
