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Gut gateway to generalized pain

  • Arnold Berstad EMAIL logo and Jørgen Valeur
Published/Copyright: October 1, 2016
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 13 Issue 1

In this issue of Scandinavian Journal of Pain, Marum and coworkers [1] report that a diet low in FODMAPs, “fermentable oligo-, di- and monosaccharides, and polyols”, is effective in treating complaints related to fibromyalgia, a rheumatic disease characterized by widespread myofascial pain of unknown aetiology.

1 Fermentable oligo-, di- and monosaccharides, and polyols = FODMAPs may aggravate fibromyalgia symptoms

The authors performed an open pilot study on the effect of a low-FODMAP diet in 38 patients with fibromyalgia. The main comorbidity of the cohort was irritable bowel syndrome (IBS) and some form of food intolerance. The low-FODMAP diet has emerged as an established therapy in IBS [2]. Consistent with prior studies, scores on IBS symptom severity decreased by 50% after one month on the diet [1]. The new findings are that the impact of fibromyalgia scores also decreased (by 22%) and scores of improvements for fibromyalgia and IBS were significantly correlated to each other and to compliance with the diet [1].

2 Low-FODMAP diet improves fibromyalgia symptoms – also in controlled studies?

Marum and co workers [1] highlight the importance of the relationship between fibromyalgia and gastrointestinal disturbances and suggest that diet might constitute an important part of the therapy. Patients with such “medically unexplained physical symptoms” are often frustrated due to lack of effective treatment. We suspect that such frustration may complicate an open trial evaluation of a dietary intervention. Experiencing relief of abdominal discomfort, the patients may become over-enthusiastic and liable to score the total benefit, including relief of musculoskeletal pain, a little too generously. Further controlled studies are therefore required.

3 Fibromyalgia syndrome and irritable bowel syndrome

Fibromyalgia is characterized by chronic generalized pain accompanied by a broad spectrum of symptoms from various organs, including food intolerances and IBS, that are commonly overlooked [3]. The central sensitivity syndrome is a novel concept embracing the biopsychosocial model of the condition [4]. However, this concept implies nothing about where and how the abnormality begins. According to our personal experience, the patients regularly report abdominal complaints, often years before the appearance of musculoskeletal pain [5]. Also, a majority of the patients feel that diet helps, at least for their food intolerances. Nevertheless, current therapy is still largely based on a psychological approach.

4 Disturbed gut microbiota associated with the triad: fibromyalgia–IBS–chronic fatigue

The present study is important because it may be the first to suggest that a diet low in FODMAPs may be beneficial in fibromyalgia. The suggestion is timely: diet has a considerable influence on the gut microbiota [6], and disturbances of the gut microbiota (“dysbioses”) are associated with a number of diseases, including “medically unexplained physical symptoms”, such as IBS, fibromyalgia and chronic fatigue syndrome [7]. Studies in animal models clearly document that gut microbiota alters brain functions (“microbiota–gut–brain axis”) [8] suggesting that the gut may be a gateway to generalized pain, including the pain experienced by patients with fibromyalgia.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.07.004.

  1. Conflict of interest: None declared.

References

[1] Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Guerreiro CS. Low FODMAP diet reduce pain and improve impact on daily life of fibromyalgia patients. Scand J Pain 2016;13:166–72.Search in Google Scholar

[2] Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr 2016;55:897–906.Search in Google Scholar

[3] Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 2007;36: 339–56.Search in Google Scholar

[4] Slim M, Calandre EP, Rico-Villademoros F. An insight into the gastrointestinal component of fibromyalgia: clinical manifestations and potential underlying mechanisms. Rheumatol Int 2015;35:433–44.Search in Google Scholar

[5] Berstad A, Undseth R, Lind R, Valeur J. Functional bowel symptoms, fibromyalgia and fatigue: a food-related triad? Scand J Gastroenterol 2012;47:914–9.Search in Google Scholar

[6] Maukonen J, Saarela M. Human gut microbiota: does diet matter? Proc Nutr Soc 2015;74:23–36.Search in Google Scholar

[7] Collins SM, Bercik P. The relationship between intestinal microbiota and the central nervous system in normal gastrointestinal function and disease. Gastroenterology 2009;136:2003–14.Search in Google Scholar

[8] Mu C, Yang Y, Zhu W. Gut microbiota: the brain peacekeeper. Front Microbiol 2016;7:345.Search in Google Scholar
Published Online: 2016-10-01
Published in Print: 2016-10-01

© 2016 Scandinavian Association for the Study of Pain

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  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
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  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
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  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
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  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
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  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
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  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
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https://doi.org/10.1016/j.sjpain.2016.06.001

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
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