Management of Pain in Gastritis

Introduction to Gastritis Management

The American Gastroenterological Association recommends optimizing medical therapies that modulate pain from visceral stimuli while incorporating non-pharmacological approaches, avoiding opioids, and establishing a collaborative patient-provider relationship 1, 2

Proton pump inhibitors (PPIs) are efficacious first-line treatments for gastroduodenal disorders including gastritis, as they reduce acid production and allow healing of inflamed gastric mucosa 2, 3
Antispasmodics can be effective for pain management in gastritis 4

Non-pharmacological therapies should be considered routinely as part of comprehensive pain management and ideally introduced early in care 2, 5
Cognitive behavioral therapy has been supported by more than 30 randomized controlled trials for gastrointestinal pain 4
Gut-directed hypnotherapy focuses on somatic awareness and down-regulation of pain sensations through guided imagery 4
Mindfulness-based stress reduction can decrease visceral hypersensitivity and improve cognitive appraisal of symptoms 4

Tricyclic antidepressants (TCAs) rank first for relief of abdominal pain in gastrointestinal disorders 4
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective alternatives for patients who cannot tolerate TCAs 1, 2
Mirtazapine may be beneficial for certain patients with persistent gastritis pain 1

Opioids should never be prescribed for chronic gastrointestinal pain as they are ineffective and potentially harmful, with risk of developing narcotic bowel syndrome 6, 2

Develop a collaborative, empathic patient-provider relationship to address management of persistent pain 1, 7
Educate patients on the pathogenesis of pain, including the role of the gut-brain axis and psychosocial contexts contributing to pain 7
Set shared goals and expectations for pain management with the patient 1
Differentiate when gastrointestinal pain is triggered by visceral factors versus centrally mediated factors to guide appropriate treatment selection 2

Avoid pain catastrophizing by refraining from language suggesting the patient "shouldn't be in so much pain" or continuing to order tests to find the "cause" of pain 6
Recognize that factors that initiate problems are not always the same as those that perpetuate the problem 6
Be aware that psychological inflexibility and overfocusing on a cause or solution can interfere with pain acceptance and response to treatment 6
Avoid tramadol, which is considered an opioid and has potential for addiction and other opioid-associated adverse events 6