Study: Nutrition for gut microbiota could aid pain management

The authors from China explored the interplay between gut microbiota, nutrition, and pain, suggesting an avenue for addressing the complexities of chronic pain conditions. 

They state: “Precise nutrition and microbiota intervention strategies can directly or indirectly affect pain through endocrine, immune, and neural systems.

 “This approach marks a paradigm shift in pain treatment, hinting at a future where a holistic understanding of bodily systems brings relief to those suffering from persistent discomfort.” 

Significance​

Pain, the complex sensory experience​, is subjective and involves nociception​, the peripheral nervous system (PNS) processing of noxious stimuli, emotional, cognitive, and social components.

Chronic pain is notably more disruptive​ and detrimental to quality of life than acute pain, but lacks complete understanding in terms of its molecular and cellular mechanisms, according to the authors. 

The various types of chronic pain include visceral, inflammatory, headache, and neuropathic pain, each requiring distinct treatment approaches​.  

Examples include the challenge of managing pain in Crohn's Disease (CD) patients​ and the difficulty in addressing neuropathic pain due to distal symmetric polyneuropathy in diabetes patients​.

The authors mention that previously, a systematic review​ found that no conclusions could be drawn about the efficacy of the majority of nutrition interventions for CD (e.g., low FODMAP diet or kefir diets) in treating pain intensity and pain frequency.

However, they note the gut microbiota is a notable ecosystem in the body​, crucial for maintaining health and regulating functions like gut-barrier integrity, immune balance, and brain development.

Probiotics, prebiotics, synbiotics, postbiotics, and faecal microbiota transplantation​ (FMT) have been researched​ as potential technologies to regulate gut microbiota.

Given the increasingly recognised potential of gut microbiota, its role in the regulation of pain​ has been attracting attention.

The authors suggest microbiota can mediate the bidirectional communication between the gut and pain​ through interaction between bacteria and their composition or metabolites, such as short-chain fatty acids (SCFAs), bile acids (BAs), and tryptophan metabolites. 

The state: "Mounting preclinical and clinical evidence strongly supports the critical involvement of gut microbiota in visceral pain​, inflammatory pain​, neuropathic pain​, and even headache by attenuating pain hypersensitivity​.” 

The authors suggest that this is partially through a TRPV1-mediated mechanism​, the pain-sensing, ligand-gated, non-selective cation channel expressed in peripheral sensory neurons.

The study​

The authors used bibliometrics, a statistical analysis of publications focused on scholarly publications and academic value, to identify characteristics of the global scientific output over the past 20 years, aiming to capture how nutrition can modulate gut-pain link.

Papers were searched in the Web of Science database, with 1551 papers researching the relationship between gut-microbiota and pain from 2003 to 2022.

While the authors’ search was expansive, they note that only 122 papers discussed how nutritional interventions can modulate this link, suggesting a lack of research in this space. 

However some previous studies on conditions like CD​ and diabetic sensorimotor polyneuropathy (DSPN)​ indicate that combining nutrition and microbiota interventions can help alleviate pain. 

It is suggested by the authors of the new study that probiotics and prebiotics could represent innovative strategies for managing chronic pain by targeting gut microbiota.

In one previous animal study​ it was suggested that probiotics could play a role in improving pain.  

Additionally, previous studies have researched Bifidobacterium​​, Lactobacillus​ genera, and ​Akkermansia muciniphila (A. muciniphila)​​ in relation to pain improvement in patients with irritable bowel syndrome (IBS) through faecal microbiota transplantation.

One mouse study​ revealed that specific probiotic therapy attenuates antibiotic-induced visceral hypersensitivity through modulating sensory neurotransmitter content in the colon and altering visceral perception.

Additionally, specific probiotic therapy has been shown to modulate sensory neurotransmitter content​ and alter perception, while SCFAs produced through bacterial fermentation of dietary fibres in the gut have been linked to chronic pain modulation.  

The authors conclude: “Prebiotics only, or combined with probiotics, could be used as an intervention to relieve pain in various diseases for treating gastrointestinal and psychosocial health symptoms, from cancer​ to functional bowel disorder​, IBS​, inflammatory bowel disease (IBD), and constipation.​” 

However, despite these potentials, only a limited number of publications have explored prebiotics as preventive and therapeutic tools for managing chronic pain, so the authors conclude: "Larger studies should address how prebiotics modulate pain through gut microbiota.

Journal: Nutrients

https://www.mdpi.com/2072-6643/15/17/3704​

“Global Trends in Research of Pain–Gut-Microbiota Relationship and How Nutrition Can Modulate This Link.”

Authors: Gaochen, Sheng Zhang, Rui Wang, Zulun Zhang, Weihong Wang, Quan Wen, Faming Zhang, and Pan Li.