A link between a condition causing chronic pain and changes in the gut microbiome has been found by scientists.

Fibromyalgia affects 2-4% of the population and does not have any known cure. Symptoms include fatigue, disrupted sleep, and cognitive problems, but the condition is most specifically characterized by chronic pain that is widespread. A research team based in Montreal has shown, for the first time in a paper published today in the journal Pain, that there are improvements in the bacteria in the gastrointestinal tracts of people with fibromyalgia. In the microbiomes of patients suffering from the disease, approximately 20 different species of bacteria are present in either greater or lesser concentrations than in the stable control group.

Increased presence or absence of certain bacterial species

“We used a variety of techniques, including Artificial Intelligence, to verify that the improvements we saw in fibromyalgia patients ‘ microbiomes were not induced by factors such as diet, medication, physical activity, gender, etc. that are known to affect the microbiome,” says Dr. Amir Minerbi of the Alan Edwards Pain Management Unit at the McGill University Health Center (MUHC) and first of all. The team also included scientists from the University of Montreal and the University of Montréal as well as others from the MUHC Research Institute.

Dr. Minerbi continues, “We find that fibromyalgia and fibromyalgia symptoms–pain, exhaustion, and mental problems–lead more than any of the other causes to the differences we see in those with the disease’s microbiomas. We also saw that the frequency of the symptoms of a patient was directly correlated with an increased presence or a more pronounced absence of certain bacteria–something that was never previously reported.

Are bacteria just the markers of the disease?

It is not clear at this point whether variations in intestinal bacteria seen in fibromyalgia patients are merely symptoms of the disease or whether they play a role in causing it. Because the disease involves a cluster of symptoms and not just pain, the next step in the research will be to investigate whether there are similar changes in the intestinal microbiome in other conditions involving chronic pain, such as lower back pain, headaches and neuropathic pain.

Researchers are also interested in investigating whether bacteria play a causal role in pain and fibromyalgia development. And whether their involvement can ultimately help find a cure and improve the diagnostic process.

Confirming a diagnosis and taking steps to find a cure

Fibromyalgia is a difficult-to-diagnose condition. Patients can wait for a final diagnosis for up to 4 to 5 years. But there may be a shift in this.

“We sorted by large amounts of data, identifying 19 species that were either increased or decreased in individuals with fibromyalgia,” says Emmanuel Gonzalez of the Canadian Center for Computational Genomics and McGill University’s Department of Human Genetics. “By using machine learning, our software was able to diagnose fibromyalgia with an accuracy of 87 percent, based solely on the composition of the microbiome. We hope to improve this reliability by building on this first finding with more research, potentially creating a step-change in diagnosis.

“People with fibromyalgia not only suffer from the effects of their illness, but also from parents, friends and health teams ‘ difficulties in recognizing their symptoms,” says Yoram Shir, senior author on the journal, who is the Administrator of the MUHC Alan Edwards Pain Management Unit and an Associate Investigator of the RI-MUHC BRaiN Project. “We are frustrated as pain doctors with our inability to help, and this anger is a good fuel for science. This is the first proof that the microbiome may have an impact on diffuse pain, at least in humans, and we really need new ways of looking at chronic pain.

How was the research done?

The study was focused on a cohort of 156 Montreal-area people, 77 of whom have fibromyalgia. Study participants were examined and given vomit, blood, saliva, and urine samples that were then compared to those of healthy control subjects, some of whom lived in the same house as fibromyalgia patients, or were their parents, children, or siblings.

The next steps of the researchers will be to see whether similar results are obtained in another study, perhaps in another part of the world, and to do animal studies to find out if changes in bacteria play a role in the disease’s growth.

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Reference: Minerbi, A., Gonzalez, E., Brereton, N. J. B., Anjarkouchian, A., Dewar, K., Fitzcharles, M.-A., … Shir, Y. (2019). Altered microbiome composition in individuals with fibromyalgia. PAIN, Articles in Press. https://doi.org/10.1097/j.pain.0000000000001640