The gut-brain axis is a new idea in medicine whose importance is growing.  This Canadian study of fibromyalgia patients adds this very common condition to a list of pain disorders that are linked to the microbiome, or the ecosystem of the gut.


Researchers found that fibromyalgia patients had several differences in their gut bacteria as compared to controls.  These bacteria produced lower levels of butyrate and propionate, which are short-chain fatty acids that lower inflammation in the body.  


This is just one of several complex ways in which gut bacteria can influence chronic pain.  We are just beginning to understand this world within us, but we do know that these bacteria interact with the nervous system in many fascinating ways.


Will probiotics improve your chronic pain?  There is some evidence that it might.  This double-blind study found benefit in knee osteoarthritis, this oneshowed a reduced risk of chronic pain after wrist fracture and this review of 21 trials showed reduced symptoms when used to treat irritable bowel syndrome. 


This study shows correlation, but not causation.  It may be that fibromyalgia causes changes in the gut that promote the growth of different bacteria.  Just like vitamin D deficiency, this may be a chicken and egg puzzle that only future studies can solve.


As with any treatment, every person will respond differently.  We advocate a rational prescribing approach, which means that you assess each treatment with Ωa structured trial.  If you are working with a knowledgeable provider, and using products made by reliable manufacturers, a 1-2 month trial of a probiotic should tell you whether it will improve your pain or other symptoms.
The body is interconnected in so many ways, which is why integrative medicine is an approach that makes so much sense.  We believe it is the future of healthcare.  

Dr. Richard Nahas
MD CCFP DCAPM ABIM