THE MICROBIOTA AND PAIN
Our microbiota is the community of microorganisms within our gut. A healthy microbiota is vital for an individuals health and wellbeing. Individuals with chronic pain conditions, including visceral pain, fibromyalgia, chronic pelvic pain, and osteoarthritis-related pain, all display alterations in microbiota diversity and abundance compared to a healthy individual. Therefore disruption of an individuals microbiota may play an essential role in modulating and perpetuating chronic pain. The manipulation of the gut microbiota through dietary interventions should be considered for improving pain outcomes in chronic pain patients.
Microglia, the gut and chronic pain
Microglia are immune cells located in the central nervous system (spinal cord and brain). Microglia are involved in the modulation of both acute and chronic pain. Studies suggest that communication between the gut microbiota and microglia is involved in the development and persistence of chronic pain conditions. Dietary and supplemental strategies that manipulate or restore the gut microbiota may reduce microglial activation and thus reduce inflammation and associated symptoms, such as pain.
The importance of gut-brain communication
The gut, microbiota and brain communicate with each other via the microbiota-gut-brain axis. This communication is bidirectional and involves both nerves and chemicals. The communication between the gut microbiota and the brain is understood to regulate healthy gastrointestinal function and affect central nervous system function, including cognition, mood, and pain perception. Gut, brain and systemic inflammation occur in both acute and chronic stress and mood disorders. Stress has a direct effect on the GI tract, increasing intestinal permeability and modifying the gut microbiota.
Dysbiosis refers to a decrease in microbial diversity and loss of beneficial microorganisms in the gut. Dysbiosis in the gastrointestinal tract has been associated with visceral pain conditions, such as irritable bowel syndrome (IBS) and pancreatitis, and several neurological inflammatory conditions, such as depression and Parkinson’s disease, showing therapeutic promise in microbial manipulation using pre and probiotics. Additionally, restoration of the gut microbiome following dysbiosis has been shown to improve pain responses of visceral, inflammatory and neuropathic pain.
Food serves as an important source of nutrients and modulates various physiological functions in the gastrointestinal tract, including intestinal barrier function.
An intact intestinal mucosal barrier is vital for absorbing nutrients while stopping harmful microorganisms and toxins from crossing into the body. The intestinal mucosal barrier can be damaged by medications, stress, a western-style diet, autoimmune conditions and dysbiosis.
Adequate intake of, vitamins minerals, macronutrients, and trace elements from foods is vital for maintaining a healthy intestinal barrier function. Particular vitamin and mineral deficiencies such as vitamin A, vitamin D and zinc have been found to damage the epithelial barrier of the gut with an increased risk of inflammation and infection. Restoring the intestinal barrier to its proper function is therefore indicated in chronic inflammatory and associated pain conditions.