Given the high prevalence of psychiatric disorders and functional pain syndromes in the IBD population, the use of psychiatric consultation and antidepressant medications is a powerful tool [7]. Medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating pain in patients with underlying psychiatric illness or functional pain syndrome (most commonly IBS).

Constipation as a result of intestinal dysmotility can be a significant player in the development of abdominal pain in IBD that is rarely recognized or addressed. This issue often has a good deal of overlap with IBS and psychiatric disorders clinically. The cycles of inflammation and healing in patients with IBD can lead to damage of glial cells and the interstitial cell of Cajal and to the calcium channels in intestinal smooth muscle resulting in dysmotility and/or pain even when inflammation has resolved [9–11]. With the aid of detailed history taking and abdominal x-ray, constipation and/or dysmotility can be diagnosed and thus treated appropriately.

Additionally, when patient’s Crohn’s disease appears to be endoscopic in remission, but continues to have ongoing abdominal pain, one can consider the possibility of fibro-stenotic strictures or intra-abdominal adhesions as a cause for the pain. These being either beyond the reach of standard or extraluminal endoscopy can be missed by standard evaluations. Collaboration with a GI radiologist and or an advanced endoscopist may be helpful in evaluating these patients when this is suspected. If either is present, surgery would be the appropriate treatment to alleviate the pain rather than continued narcotics.