There is a power to non-pharmaceutical interventions
The Gut Microbiome as a Diagnostic Tool for Endometriosis and Fibromyalgia: What is the Cause of Chronic Pain?
The abnormal tissues range from blisters to cysts. They grow throughout the pelvic cavity, latching on to the ovaries and peritoneum or infiltrating the bowel and bladder.
The inflammatory condition of endometriosis can be removed if it’s detected. It’s possible for a quarter of people who opt for this to have to have another surgery within five years. Doctors and surgeons want to remove diseases. But people’s pain persists more often than we like to report,” says Amira Quevedo, an obstetrician-gynaecologist who runs endometriosis clinical trials at the University of Florida in Gainesville.
The number, size, or type of disease a person has isn’t the most relevant indicator of the pain they experience. For some people pain gets worse during their period, for others it lasts all month. It can manifest as searing muscle spasms, or as vaginal, bowel or bladder pain that spreads across the pelvis and beyond.
Many kinds of chronic pain are a result of this persistence of pain after the original stimuli are gone. In some whole-body pain conditions, such as fibromyalgia, there is no clear cause. Something has tripped the pain system into overdrive, prompting a desperate search for relief.
Several diseases that engender long-term pain are also disproportionately experienced by women — among them are endometriosis and fibromyalgia. There is hope that manipulating the gut microbiome could provide relief for certain conditions because of new research linking chronic pain to the composition of the gut.
In studies of Irritable bowel syndrome, there was a connection between the gut and chronic pain. Visceral pain comes from the body’s organs.
Most studies capture only a snapshot of the gut microbiome. Cryan says that longitudinal studies are required to track the changes in the microbiome during and after treatment. His research shows that early life stress leads to persistent pain in adulthood, despite the recovery of the gut microbiome. He says the microbiome is not a reflection of pain pathology; it might be something that happened way earlier.
Dodds and Maddern discovered that the cells in the spine can drive a process called central hypersensitivity which causes pain. In female mice with long-standing endometriosis, the spinal cord’s resident support cells — microglia and astrocytes — amass, become overly reactive to and amplify pain signals6,7. Chronic pain is more likely to persist even without stimuli, if the pain pathways become hypersensitive to peripheral inputs such that light touch becomes unbearable. Several researchers who have studied the effects of endometriosis in mice have reported swollen and activated brain cells. There are models of Fibromyalgia with activated microglia.
In 2020, 72 people with the disease will be randomly given either a placebo or a low-dose of the drug. The two groups showed no differences in pain six weeks after surgery13, but Quevedo remains optimistic. Six months after surgery, and annually for five years, participants in the trial will be able to report their symptoms and learn about chronic pain in a more relevant way.
The team found in a study that the people with Fibromyalgia had lower levels of specific bile acids in their blood. People with Fibromyalgia tend to lack these bile acids. The lower the level of bile acids circulating, the more intense the pain they had to deal with. Without them, pain might flare unchecked. The levels of bile acids could be restored to make a difference in pain.
Pain and Addiction: The Pacira Biosciences Inc. State of the Art and Prospects for Research Applications in Human Orthopaesthesia
People spend much of their lives trying to soothe physical pain. The global over-the-counter analgesics market is estimated to be worth over US$28 billion in 2022, and it is expected to reach almost $41 billion by 2032. At the same time, the massive overconsumption of pain-management opioid drugs, which can be addictive, continues to shatter lives.
We are pleased to acknowledge the financial support of Pacira Biosciences Inc. in producing this Outlook. As always, Nature retains sole responsibility for all editorial content.
The treatment of pain should involve a more nuanced understanding of how it feels. Pain-o-meter devices are emerging that could finally bring precision and objectivity to every carer’s first question: “where and how much does it hurt?”. Researchers are trying to determine if a brain or blood test can give a prediction on which therapies will work best for people with chronic pain.
Amira Quevedo, an obstetrician-gynecologist at US’ University of Florida, has claimed that manipulating the gut microbiome could provide relief for endometriosis andFibromyalgia. “There’s hope that manipulating the gut microbiome could provide relief for certain conditions because of new research linking chronic pain to the composition of the gut,” she added. Amira runs endometriosis clinical trials at University of Florida.