Patients with IBD commonly suffer from abdominal pain.Whilethe pain may originate from worsening inflammation and/or its complications, chronic pain in IBD can have multiple influences.In particular, chronic pain is frequently driven by dysregulation of neurophysiological processes at spinal and supraspinal levels, and thus can be influenced by psychosocial factors that upregulate central pain control systems. Therefore, a comprehensive understanding of IBD pain in terms of peripherally (gut) and centrally (brain and spinal cord) acting factors is required. This has important therapeutic implications for the treating physician as the management of centrally driven chronic pain may evoke more centrally targeted treatments in addition to or instead of anti-inflammatory agents, for example. The strategies for chronic pain management lie in an effective physician–patient relationship, narcotic tapering, and psychopharmacological and behavioral treatments.This article details the pathophysiology of chronic pain in IBD and treatment strategies. Inflamm Bowel Dis Monit 2009;10(1):1–10.