Abstract
Background: Pain is a commonly reported and disabling symptom of inflammatory bowel disease (IBD) and has a significant impact on a patient’s quality of life, mood and functioning. While over two thirds will experience pain during active disease, a significant proportion (20-50%) of patients report pain in remission. A lack of clinical and endoscopic markers of active disease in the presence of pain is distressing for patients and challenging for clinicians. Preliminary research demonstrates that IBD-pain is a multifactorial construct, however further research is needed to better understand and effectively manage pain in IBD.Aim: The aim of this thesis was to develop and feasibility test a self-management intervention for chronic pain in IBD.
Methods: The Medical Research Council (MRC) framework and Behavioural Inhibition System/Behavioural Activation System (BIS/BAS) theory of chronic pain were used to guide intervention development. A systematic review examined psychosocial factors associated with pain in IBD. A cross-sectional study evaluated the association between psychosocial factors identified in the review and other psychosocial factors. A qualitative study explored experiences, current management strategies and needs for an intervention for pain. Finally, a feasibility study assessed the feasibility and acceptability of a self-management intervention and gained preliminary estimates of efficacy on pain and psychosocial processes.
Results:
• The systematic review including 15 studies (paper 1) found cognitive, emotional and behavioural processes associated with pain, yet highlighted that further research was required using validated pain measures and to investigate psychosocial factors identified but not yet explored in IBD.
• The cross-sectional study (paper 2) (n=297) confirmed psychosocial factors identified in the review such as depression, anxiety and pain catastrophising. It also demonstrated cognitive and behavioural processes such as symptom focusing, avoidance resting behaviour and pain self-efficacy were associated with pain.
• The qualitative study (paper 3) (n = 14) identified three themes; i) vicious cycles ii) finding solutions and iii) attitudes. It found that pain is rarely experienced in isolation but with other symptoms of fatigue and urgency in IBD.
• Cognitive behavioural therapy techniques were used to target psychosocial processes in a BIS/BAS model of IBD-pain. Patient public involvement ensured that the intervention was tailored to people with IBD-pain. The intervention was delivered online with facilitator support over 9 weeks.
• A feasibility study (n=20) (paper 4 – submitted) demonstrated that the online intervention was acceptable, as participants understood the workings of the intervention and felt confident in their ability to complete sessions and tasks. Despite low recruitment rates, feasibility was demonstrated through usage and completion of the intervention and adequate provision of facilitator support. Scores improved for quality of life and reduced for negative affect and cognitive-behavioural processes. However, the study was not powered to detect significance in outcome measures, thus warranting further investigation in a randomised controlled trial.
Discussion: Overall, this thesis demonstrated the development, feasibility and acceptability of a CBT-based self-management intervention for IBD-pain and has enabled a better biopsychosocial understanding of pain in IBD. A large-scale randomised controlled trial is required to formally assess the long-term efficacy and cost-effectiveness of the intervention
| Date of Award | 1 Apr 2020 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Christine Norton (Supervisor), Wladzia Czuber-Dochan (Supervisor) & Rona Moss-Morris (Supervisor) |