Fibromyalgia, is there also a microbial imbalance at the root of the problem?

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People with fibromyalgia have a different microbiome than people without this disease. This is what a study published in Pain shows.

People with fibromyalgia have a different microbiome than people without this disease. This is what a study published in  Pain shows .

“The abundance of some of these bacterial species is related to the severity of fibromyalgia symptoms: pain, fatigue, cognitive symptoms and sleep disturbances,” said first author Amir Minerbi, a researcher at Alan Edwards Pain Managment Unit at McGill University. Health Center, in Montreal
Artificial intelligence algorithms could automatically distinguish patients from controls, based only on the composition of their intestinal microbiome.
“Demonstrating objective results that separate fibromyalgia patients from healthy controls provides convincing evidence that fibromyalgia is a true syndrome. This is the first demonstration of the alteration of the intestinal microbiome in non-visceral pain, “highlighted Minerbi.

The study included 77 women with fibromyalgia and 79 healthy controls. A pain physician verified each participant’s diagnosis and each was carefully characterized, including eating habits, demographic characteristics, comorbidities and medications.
The bacterial DNA contained in the stool samples of each of the participants was analyzed and blood samples were analyzed for the bacteria-derived metabolites.

The researchers used advanced computational algorithms to examine the differences in microbiomes between patients and controls, as well as the possibilities for interactions between potentially confusing variables, including drugs, diet and physical activity.
Co-author Emmanuel Gonzalez, a bioinformatics specialist at the Montreal Node of the Canadian Center for Computational Genomics, used artificial intelligence algorithms to distinguish patients from controls based only on the composition of their microbiomes. They did it precisely 87% of the time.

“The variance in the composition of microbiomes has been explained by the variables related to fibromyalgia more than by any other innate or environmental variable,” the researchers pointed out in the work.
Furthermore, this variance was “correlated with the clinical indices of fibromyalgia in line with the alteration observed in the metabolic species of butyrate, the targeted analysis of serum metabolites, the verified differences in the serum levels of butyrate and propionate in patients with fibromyalgia” , the researchers observed.

Rajat Bhatt, a rheumatologist from Prime Rheumatology, in Richmond and Pearland, Texas, said the research does not explain some phenomena such as fibromyalgia patients traveling abroad that should have a change in the gut microbiome that should change the patient’s symptoms. In addition, he highlighted that when patients with fibromyalgia undergo a colectomy, for reasons unrelated to fibromyalgia, the disease is neither resolved nor altered.

Dr. Minerbi answered these questions by pointing out that of the 1,620 different bacteria found in the gut of the study participants, only 72 were significantly modified in subjects with fibromyalgia, approximately 4.5% of all bacterial taxa. Of these, some were found to have increased and others were found to have declined. It is therefore unlikely that non-specific interventions such as colectomy or travel abroad will have a specific effect on the abundance of these bacteria. “

“Fibromyalgia is a heterogeneous condition, in the sense that there are intrinsic differences in who develops it and how / why it develops,” said Andrea L. Nicol, assistant professor of anesthesiology at the Lawrence School of Medicine of the University of Kansas .

“However, it is not exactly clear whether individual differences are explained in the results,” added Dr. Nicol. “Despite these limitations, their approach and data are highly original and give credit to the need for further investigation in this area.”

The authors argued that the hypothesis that microbiome alterations may affect the processing and perception of pain has been supported by numerous animal studies showing that the gut microbiota plays an important role in the development of visceral pain of induced neuropathic pain. from chemotherapy and opioid tolerance. “

Human studies have shown “constant changes in subjects with irritable bowel syndrome (IBS) and in patients suffering from chronic dysfunctional pelvic pain. Similarly, patients with chronic fatigue syndrome (CFS), who share some symptomatic characteristics with fibromyalgia, have shown to have altered the profile of the microbiome and intestinal metabolomics “. Furthermore, alterations of the microbiome have been reported in various rheumatological diseases.


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