Pain control is often multidisciplinary and resource-intensive. Pain may be a poorly controlled symptom of ulcerative colitis (UC) culminating in significant patient dissatisfaction. The multicohort study exploring factors associated with abdominal pain in active and quiescent UC highlights the importance of attempting to prevent pain in UC. This may be achieved through understanding the risk factors that may lead to severe pain. Succeeding in this aim may allow us to minimise pain and improve the quality of life in those with UC.

Van Gils et al. [1] suggested active disease, female gender and anxiety/depression are positively associated with severe abdominal pain. The most significant association was observed in the second cross-sectional cohort where the female gender was positively associated with abdominal pain (adjusted odds ratio [aOR] 2.03; p < 0.01). This is consistent with the association of female gender and pain in other gastrointestinal diseases such as intestinal dysmotility and irritable bowel syndrome [2, 3]. In the same cohort, active disease and anxiety were both associated with abdominal pain with aORs of 2.68 (p < 0.001) and 1.99 (p < 0.001) aligning with growing understanding that the gut-brain axis is likely to interact to create the sensation of pain though the activation of visceral and nociceptive pain receptors [4, 5]. It is interesting that concurrent use of medications such as oral 5-ASA, thiopurines and anti-TNF agents were not associated with abdominal pain severity (aORs 1.27, 0.82, 1.18, respectively) as these may be considered a proxy for more severe disease and, hence, the expectation of a greater pain burden. One could argue that none of the other predictive factors associated with pain is particularly surprising. Despite this, the key strength of this study included the use of homogenous survey parameters and concordant results across the three cohorts. This provides a timely reminder that these factors play a significant role in abdominal pain. Furthermore, some of these are potentially modifiable and hence are treatable targets.

Despite the robustness of this study, a major limitation was the appropriateness of using the GSRS survey as a proxy for pain severity in patients with UC as it is more specific for upper gastrointestinal conditions [6, 7]. A more directed validated questionnaire such as Ulcerative Colitis Patient-Reported Outcomes Signs and Symptoms (UC-PRO/SS) [8] may allow for greater accuracy when recording pain from UC patients. Other limitations included the lack of granularity regarding the use of concurrent medications such as antispasmodics, acetaminophen, opiates and antibiotics. These may mask pain and indicate alternative underlying pathologies. Other tangible factors such as social stress, sleep quality, diet, previous abdominal surgeries and gut microbiome are all foreseeable predictors of abdominal pain severity in UC.

This study has set a precedent and offers a platform for improvement in future studies to incorporate new factors that predict abdominal pain in UC. It has highlighted that abdominal pain is common and troublesome for those with UC. A greater focus on mitigating against modifiable factors predictive of pain may help alleviate this.

疼痛控制通常是多学科和资源密集型的。疼痛可能是溃疡性结肠炎 （UC） 控制不佳的症状，最终导致患者严重不满。探索活动性和静止性 UC 腹痛相关因素的多队列研究强调了尝试预防 UC 疼痛的重要性。这可以通过了解可能导致严重疼痛的风险因素来实现。成功实现这一目标可能使我们能够最大限度地减少 UC 患者的疼痛并改善他们的生活质量。

Van Gils 等人 [1] 认为活动性疾病、女性性别和焦虑/抑郁与严重腹痛呈正相关。在第二个横断面队列中观察到最显著的关联，其中女性与腹痛呈正相关 （校正比值比 [aOR] 2.03;p < 0.01）。这与女性性别与其他胃肠道疾病（如肠动力障碍和肠易激综合征）疼痛的关联一致 [2， 3]。在同一队列中，活动性疾病和焦虑都与腹痛相关，aORs 为 2.68 （p < 0.001） 和 1.99 （p < 0.001），这与人们越来越认识到肠-脑轴可能通过激活内脏和伤害性疼痛受体相互作用以产生疼痛感 [4， 5].有趣的是，同时使用口服 5-ASA、硫嘌呤和抗 TNF 药物等药物与腹痛严重程度无关（aORs 分别为 1.27、0.82、1.18），因为这些可能被认为是更严重疾病的代表，因此，预期会有更大的疼痛负担。有人可能会争辩说，与疼痛相关的其他预测因素都没有特别令人惊讶。尽管如此，这项研究的关键优势包括在三个队列中使用同质的调查参数和一致的结果。这及时提醒了这些因素在腹痛中起着重要作用。此外，其中一些是潜在的可改变的，因此是可治疗的靶点。

尽管这项研究的稳健性，但一个主要的局限性是使用 GSRS 调查作为 UC 患者疼痛严重程度的代表的适当性，因为它对上消化道疾病更具特异性 [6， 7]。在记录 UC 患者的疼痛时，更直接、经过验证的问卷，例如溃疡性结肠炎患者报告的结果、体征和症状 （UC-PRO/SS） [8] 可能更准确。其他限制包括缺乏关于同时使用药物（如解痉药、对乙酰氨基酚、阿片类药物和抗生素）的粒度。这些可能掩盖疼痛并提示其他潜在病变。其他有形因素，如社会压力、睡眠质量、饮食、既往腹部手术和肠道微生物组，都是 UC 腹痛严重程度的可预见预测因子。

这项研究开创了先例，并为改进未来研究提供了一个平台，以纳入预测 UC 腹痛的新因素。它强调，腹痛对于 UC 患者来说很常见且很麻烦。更加注重减轻预测疼痛的可改变因素可能有助于缓解这种情况。