Irritable bowel syndrome: drug therapy for abdominal pain

Irritable bowel syndrome is characterized by the association of abdominal pain and bowel habits disorders. It is part of the disorders of brain gut interactions. The importance of the placebo effect is well known for this group of diseases, and according to certain authors, placebo should be considered as a treatment in its own right for irritable bowel syndrome. Drug treatment of irritable bowel syndrome pain is one therapeutic option among others, including dietary modifications, psycho-emotional behavioral therapies, and electrical stimulation. Literature data suggest that a number of dietary supplements, herbal medicines and probiotics can improve abdominal pain. Antispasmodics have moderate but demonstrated effectiveness, including peppermint oil, phloroglucinol and mebeverine. Central neuromodulators (anti-epileptics used for neuropathic pain and antidepressants) are part of the therapeutic arsenal used for intractable abdominal pain in irritable bowel syndrome: here again, the level of evidence is quite low, and the side effects frequent. Other pharmacological agents that have shown greater efficacy than placebo for the treatment of irritable bowel syndrome pain include antagonists of histamine 1 receptors, and guanylate cyclase-C agonist secretagogues. In total, many molecules are available to treat the pain of irritable bowel syndrome. However, for the most part they have limited effectiveness, and some have side effects which should prompt careful prescription.