Pain and IBD: The Contributing Role of Diet and Nutrition.

Pain is one of the most debilitating symptoms in patients with inflammatory bowel disease (IBD). We explore the impact of diet, nutrition, and malnutrition in the emergence and worsening of pain in patients with IBD, and potential strategies to prevent this complication. We propose that diet may impact pain in IBD through nociceptive, neuropathic, and nociplastic mechanisms. IBD-related nociceptive pain arises from intestinal inflammation, nerve sensitization, obstruction, and pressure due to chronic remodeling and strictures. Neuropathic pain in IBD may result from vitamin and micronutrient malabsorption. Surgery can leave patients with IBD particularly prone to vitamin B12 deficiency due to anatomical changes that hinder absorption. Nociplastic pain occurs through central pain sensitization and the experience of pain in the absence of inflammation and other known organic causes. The epidemiologic identification of a Western diet high in ultra-processed foods being associated with both IBD as well as neuropsychiatric illness may contribute to increased pain perception in patients through the gut-brain-axis. We highlight actionable clinical factors linking diet and nutrition to pain in IBD, along with emerging hypotheses on the complex interplay between diet, its prebiotic effects on the microbiome and metabolome, and disorders of gut-brain interaction that may exacerbate pain.