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Pain is the dominant symptom of IBS, regardless of the IBS subtype – IBS-D, IBS-C, or IBS mixed (IBS-M). It is the main contributor to severity in IBS. Seeking relief from pain is the most common reason that people with IBS consult with their doctor.

Like all functional gastrointestinal disorders, IBS is a disorder of brain-gut interactions. Symptoms of IBS in general are caused by the presence of biological factors that are happening inside the body, which are not easily visible.

Advances in science over the past two decades, including the microbiota of the gut, alteration of gut sensitivity, and brain imaging, have led to improved understanding about the interactions between the brain and the gut.

The pain in IBS is closely related to an altered response on the part of the brain to normal signals that arise from the gut, which “turn up the volume” on sensations. This understanding of the brain-gut connection is essential, not only to the cause of the chronic pain, but also to its treatment.

Currently, there is no sure treatment that will eliminate 100% of the chronic pain in IBS. But, there are a number of approaches that can reduce and bring the pain under control. These include self-management approaches, psychological approaches, and medications.

Opioids are not a treatment for IBS pain; there is no evidence of long-term benefit.

Finding and working with a patient-centered healthcare provider familiar with the concepts presented here will help ensure the best available care for the chronic pain and other symptoms of irritable bowel syndrome.


A pdf of this article for free download is available in the IFFGD publications library here.

About the author
Douglas A. Drossman, M.D., is President of the Rome Foundation, a non-profit organization committed to helping clinicians improve their care with patients having Functional GI Disorders. He was the founder and former Co-Director of the UNC Center for Functional GI and Motility Disorders in Chapel Hill, NC. He is also President of the Center for Education and Practice of Biopsychosocial Care, which provides education in the patient provider relationships, and is in private medical practice seeing patients at Drossman Gastroenterology located in Chapel Hill, NC. Website:

For healthcare providers: Here is a video of a presentation by Douglas A. Drossman delivered at the UCLA GI Week 2016 on the topic, "State of the Art Lecture: Understanding and Management of Patients with Chronic Abdominal Pain and Narcotic Bowel Syndrome."

We are grateful to The Allergan Foundation for a health and human services educational grant in support of this publication.



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