Table 4. Recommendations for treatment of pain in IBS.

Therapy	Try therapy
Peripheral analgesics	Rather not	[Evidence level B (paracetamol), evidence level D for other drugs, recommendation strength ↓, strong consensus]
Opiates and opiate agonists	Virtually never	[Evidence level A for kappa agonists, evidence level D for µ- agonists and classical opiates, evidence level A for opiate antagonists, recommendation strength ↓↓, strong consensus]
Spasmolytics	In most patients	[Evidence level A, recommendation strength ↑, strong consensus]
Soluble fiber	In some patients	[Evidence level A, recommendation strength ↑, strong consensus]
Tricyclic antidepressants	In some patients	[Evidence level A, recommendation strength ↑, strong consensus]
SSRIs	In some patients	[Evidence level A, recommendation strength ↑, strong consensus]
5-HT3 antagonists	In few selected patients	[Evidence level A, recommendation strength ↑, consensus]
Probiotics	In some patients	[Evidence level A, recommendation strength ↑, strong consensus]
Antibiotics	Rather not	[Evidence level A, recommendation strength ↓, consensus]
Pregabalin/gabapentin	Rather not	[Evidence level B , recommendation strength ↓, strong consensus]
Phytotherapeutics	In some patients	[Evidence level A, recommendation strength ↑, strong consensus]
Aloe vera	Rather not	[Evidence level A, recommendation strength ↓, strong consensus]
Pancreatic enzymes	Virtually never	Þ       [Evidence level D, recommendation strength ↓↓, strong consensus]