Dear Dr Murthy,

I agree with your view on the potential of live microorganism therapy for chronic pain. It’s a promising area. However, I’m curious about the impact of tablet formulation—specifically coated versus non-coated forms. Would a coated tablet better protect the live microbes from stomach acid, allowing more to reach the gut intact? On the other hand, could non-coated tablets risk microbial loss before reaching their target site? Understanding how formulation affects microbial survival and activity in the gut seems crucial in ensuring the therapy's effectiveness. I'd value your thoughts on this aspect.

Regards

YYmalaysia

Yes, there is new research that microorganisms in the gut help to decrease the pain originating in fibromyalgia.

Gut microbial supplements, also known as probiotics, prebiotics, or postbiotics, have shown promise in managing chronic painby modulating the gut microbiome. Chronic pain, often associated with conditions like fibromyalgia, arthritis, and neuropathy, has been linked to disruptions in the gut-brain axis, a bidirectional communication pathway between the gut and central nervous system. Here's an overview of how gut microbial supplements can help:

Mechanisms Linking Gut Microbiota to Chronic Pain Relief

1. Reduction in Inflammation

Gut microbes play a crucial role in modulating systemic inflammation by influencing the production of anti-inflammatory cytokines.

Probiotics like Lactobacillu and Bifidobacterium reduce pro-inflammatory mediators, which are often elevated in chronic pain conditions.

2.Neuromodulation through the Gut-Brain Axis

Microbial metabolites, such as

short-chain fatty acids (SCFAs), directly influence the nervous system by promoting healthy communication along the gut-brain axis.

These metabolites reduce hypersensitivity and overactivation of pain pathways.

3. Enhanced Endocannabinoid System Function

Certain gut microbes interact with the endocannabinoid system, which regulates pain perception. Supplements that restore gut microbial diversity may enhance this system's analgesic effects.

4. Stress and Anxiety Reduction

Chronic pain is often worsened by stress and anxiety, which are modulated by gut microbiota.

Probiotics improve serotonin and GABA levels, contributing to mood stabilization and reduced pain sensitivity.

5.Immune System Regulation

Gut health supplements restore immune balance, mitigating auto-immune responses and inflammation that exacerbate chronic pain conditions.

Evidence from Research Studies

1. Fibromyalgia and Gut Dysbiosis

Research has found altered gut microbiota in individuals with fibromyalgia. Probiotic supplementation improved symptoms like fatigue and pain intensity.

2. Irritable Bowel Syndrome (IBS) and Pain Management

Probiotics such as Lactobacillus reuteri reduced abdominal pain in IBS patients, suggesting that similar mechanisms could be applied to chronic pain conditions.

3. Neuropathy and SCFAs

Studies indicate that SCFAs derived from prebiotics improved nerve function and reduced neuropathic pain in animal models.

4. Post-Surgical Pain

Gut microbial restoration post-surgery with probiotics was linked to faster recovery and reduced chronic pain development.

Key Supplements for Chronic Pain Relief

Probiotics

Lactobacillus acidophilus: Reduces pain perception.

Bifidobacterium infantis: Lowers systemic inflammation.

Prebiotics

Non-digestible fibers (e.g., inulin, fructooligosaccharides) promote beneficial microbial growth.

Postbiotics

Fermented products containing microbial metabolites directly contribute to gut health.

There are many similarities with the pain processes behind migraines!

Perhaps discussion of 'pathways' can be distracting, and there is another way of that looks at the sympathetic/parasympathetic neuronal systems and how it is influenced by the gut biome

Yes of course the neurophysiological pathways are important, but in migraines (and probably many other pain conditions such as fibromyalgia) the control of activity of these pathways is the key issue

We can view migraines as a generalised neuronal hyperexcitability disorder. Neuronal excitability is a normal state, otherwise we would be dead! The control of balance of the processes is led by the sympathetic-led increase the excitability (eg the fight/flight response) and the parasympathetic-led decrease in excitability (eg the vagal system)

In the gut, the 'wrong' biome, led by an overgrowth of the wrong bacteria, causes the columnar cell lining the gut to become leaky (or more leaky than it should be). This allows partly digested longer chain peptides from enzymatic protein digestion to pass into the interstitial areas of the gut where there is a rich plexus of afferent sensory nerve endings. These longer chain peptides are pro-inflammatory and these stimulate the sypathetic fibres whic then cause increased generalised neuronal excitability - the hyperexcitability that then causes an increased likelihood of a migraine attack.

In migraine treatment there are many routes to reduce this generalised excitability. Very occasionally, improving the gut biome can result in the total cessation of migraines, but usually it only reduces them

Chris