When cramping and abdominal pain from Crohn’s disease feels unmanageable, you may want to take pain medicine for relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) are common choices for pain, but they can sometimes make the problem worse for people with Crohn’s.
“The American College of Gastroenterology in the most updated guidelines recommends avoiding NSAIDs because they have been associated with an increased risk of Crohn’s disease flares,” says Jamil Alexis, MD, a gastroenterologist at Stamford Health in Stamford, Connecticut.
However, you may be able to get by with some NSAID use if your doctor gives you the go-ahead. “Newer data shows that short courses of NSAIDs are well tolerated without causing any exacerbation of Crohn’s disease or ulcerative colitis,” says Jill Gaidos, MD, a gastroenterologist with Yale Medicine in New Haven, Connecticut, and associate professor of medicine at the Yale School of Medicine.
Why You May Need to Limit or Avoid NSAIDs With Crohn’s
Taking NSAIDs may worsen symptoms for some people with Crohn’s, but research hasn’t shown consistent results confirming this outcome across the board. Experts aren’t sure why NSAIDs can cause Crohn’s flares for some people, but these drugs block key enzymes that normally produce gut-protecting compounds, which experts believe may worsen Crohn’s symptoms.
NSAIDs can damage the lining of your gastrointestinal tract (intestinal mucosa), says Dr. Alexis. “Damage to the intestinal mucosa can trigger a cascade of inflammation that may lead to a severe disease flare, potentially requiring hospitalization.”
“In general, prolonged use of NSAIDs can cause ulcers in the upper GI tract, which can result in bleeding as well as anemia,” says Gaidos. “For that reason, we don’t recommend long-term NSAID use, or we recommend adding an acid-suppression medication to try to prevent injury to the upper GI tract for anyone who needs long-term NSAIDs.”
However, some research also suggests prior studies on NSAIDs and inflammatory bowel diseases (IBDs) like Crohn’s may have overestimated how much of an impact these pain relievers have on Crohn’s symptoms.
Short-term use is typically well-tolerated, says Gaidos, who recommends NSAIDs for her patients with Crohn’s who have a musculoskeletal injury (such as a muscle sprain or bone fracture) or need additional pain relief for no more than two weeks.
5 Alternatives to NSAIDs for Crohn’s Pain
Experts don’t recommend NSAIDs for chronic Crohn’s-related pain, but you can ease your discomfort in other ways. “A key step would be to find the source of the pain and address it instead of using pain medications to just address the symptom,” says Gaidos.
Be sure to talk to your doctor about any pain you’re experiencing. They can help you identify the source of the pain and recommend a medication or another strategy that’s safest and most helpful for you. Some options that may help you get relief include:
1. Acetaminophen (Tylenol)
Some studies show acetaminophen (Tylenol) is one of the most common pain medications recommended and used for IBD. Although one meta-analysis found that taking Tylenol was linked to an increased risk of Crohn’s flares, other clinical trials have found it safe for chronic abdominal pain in people with Crohn’s.Talk to your doctor before trying it to make sure it’s right for you.
2. Gut Nerve Medications
Normally used for depression and anxiety, prescription antidepressants (at lower dosages) may also help with abdominal pain by improving disordered gut-brain interactions that contribute to pain. Your brain and gastrointestinal (GI) system communicate all day to regulate a long list of bodily functions, including hunger, digestion, mood, and pain sensitivity.
When used to help with GI symptoms, antidepressants are known as gut neuromodulators (gut nerve medications). These include:
Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and milnacipran (Savella)
Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
Tricyclic antidepressants like amitriptyline, nortriptyline (Pamelor, Aventyl), doxepin (Sinequan, Adapin)
Bupropion (Wellbutrin, Zyban)
3. Corticosteroids
Corticosteroids like prednisone (Deltasone) or budesonide (Entocort EC) fight inflammation and diminish the immune response, both of which can improve symptoms of Crohn’s disease, including pain. But these medications are best for short-term use only. They tend to work less the more you take them and come with harsh side effects and complications like weight gain, diabetes, osteoporosis, and increased risk of infections, among others.
4. Tramadol (Ultram)
If you need NSAIDs for longer than two weeks, or if NSAIDs aren’t working for you, Gaidos recommends trying tramadol (Ultram), a prescription opioid medication. Other opioids used for severe Crohn’s pain include:
codeine
hydrocodone
oxycodone
morphine
hydromorphone
fentanyl
It’s important to note that opioids aren’t recommended for long-term use in most cases because they can cause side effects like confusion, nausea, and constipation. They’re also highly addictive when taken for long periods.
“We try to avoid opioid use as much as possible due to the side-effect profile,” says Gaidos. If you need opioids for pain management in Crohn’s, you will need to work with a pain-management specialist to choose the safest option and dosage schedule possible.
5. Complementary Therapies
Instead of (or alongside) pain medications, you can try complementary therapies to reduce your Crohn’s pain.
“Different activities help with different types of pain,” says Gaidos, who recommends exercise, stretching, physical therapy, and massage for joint or musculoskeletal pain. For abdominal pain that isn’t connected to active Crohn’s disease, Gaidos suggests mind-body approaches like yoga, cognitive behavior therapy (a form of talk therapy with a mental health professional), or gut hypnosis (a form of therapy given by a trained professional to improve communication between the gut and brain).
Some studies have shown improved Crohn’s pain with the following complementary therapies:
Smaller studies have found medical cannabis may improve Crohn’s pain, but more research is needed before healthcare providers can recommend it regularly.
The Takeaway
Nonsteroidal anti-inflammatory drugs (NSAIDs) can make Crohn’s symptoms worse, although studies have not shown this consistently.
Worsened Crohn’s symptoms are more likely when taken longer than two weeks, so it’s best to avoid these medications as much as possible unless your doctor says otherwise.
Instead of NSAIDs, your healthcare provider may recommend acetaminophen (Tylenol), antidepressants, steroids, complementary therapies, or, rarely, opioids to manage your pain.
If you experience pain with Crohn’s and don’t know what to take for relief, talk to your provider, who can suggest medications or other options to ease your discomfort.
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Resources
Hunter T et al. Medication Use Among Patients With Crohn’s Disease or Ulcerative Colitis Before and After the Initiation of Advanced Therapy. BMC Gastroenterology. November 19, 2022.
Sohail R et al. Effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review. Cureus. April 3, 2023.
Cohen-Mekelburg S et al. The Association Between Nonsteroidal Anti-Inflammatory Drug Use and Inflammatory Bowel Disease Exacerbations: A True Association or Residual Bias? The American Journal of Gastroenterology. November 2022.
Keefer L et al. AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary. Gastroenterology. June 2024.
Hatamnejad MR et al. Selective Serotonin Reuptake Inhibitors and Inflammatory Bowel Disease; Beneficial or Malpractice. Frontiers in Immunology. October 5, 2022.
Bruscoli S et al. Glucocorticoid Therapy in Inflammatory Bowel Disease: Mechanisms and Clinical Practice. Frontiers in Immunology. June 3, 2021.
da Silva BC. Corticosteroid-Free Remission in Patients With Inflammatory Bowel Disease. Gastroenterology & Hepatology. March 2024.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.
