Pharmacological approaches to treat intestinal pain

• Published in: Expert review of clinical pharmacology Vol. 16; no. 4; p. 297
• Main Authors: Swierczynski, Mikolaj, Makaro, Adam, Grochowska, Agata, Salaga, Maciej
• Format: Journal Article
• Language: English
• Published: England 03-04-2023
• Subjects: Abdominal Pain - drug therapy; Analgesics - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Humans; Irritable Bowel Syndrome - drug therapy; Quality of Life; intestinal pain; inflammatory bowel diseases; irritable bowel syndrome; pharmacotherapy; Colorectal cancer
• ISSN: 1751-2441
• DOI: 10.1080/17512433.2023.2195626

Pain is one of the most substantial factors responsible for lowering quality of life in patients with intestinal diseases. Its multifactorial pathogenesis makes intestinal pain difficult to manage with currently available medications, especially considering the risk of serious adverse effects and exacerbation of underlying disease.
The most commonly administered drugs in intestinal pain are medications forming the so-called analgesic ladder, which act directly on pain sensation: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids in full range of activity strength. However, there are also many groups of supportive medications, which target intestinal pain indirectly and therefore, differs in applicability depending on underlying conditions and their pathophysiology, e.g. antispasmodics, antidepressants, probiotics, and biological anti-inflammatory drugs. In this review, we concentrated on possible analgesic options in patients suffering from irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD), and colorectal cancer (CRC). Moreover, we examined future perspectives in treating abdominal pain with medications targeting transient receptor potential channels, the endocannabinoid system and other promising options, including new formulations of already known drugs and new peripherally restricted opioids.
There is constant need for improvement of intestinal analgesia and novel pharmacological approaches, from which interaction with TRP receptors is a particularly promising direction.