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Armstrong D, Dregan A, Ashworth M, White P. Risk of fibromyalgia following antibiotic prescriptions: A population-based case-control study. Eur J Pain 2024; 28:1008-1017. [PMID: 38260960 DOI: 10.1002/ejp.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND The health of the gut microbiome is now recognized to be an important component of the gut-brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the role of the microbiome in the experience of chronic pain. METHODS A case-control study was carried out using electronic health records collected in the UK's Clinical Practice Research Datalink (CPRD), a comprehensive database of primary care consultations. For each case of diagnosed fibromyalgia, three controls were identified and matched by age, gender and GP practice. The exposure variable was the number and timing of antibiotic prescriptions over previous years. The analysis involved adjusting for a wide range of co-variates that might be possible confounders. RESULTS A total of 44,674 cases of fibromyalgia were identified together with 133,513 controls. After adjusting for co-variates, it was found that both the total number of prescriptions and their timing was associated with an FM diagnosis. For example, the quartile with the highest number of prescriptions and that with the longest exposure had a greater than three-fold increase in FM diagnoses (number of prescriptions: odds ratio 3.92; 95% CIs: 3.71-4.13; exposure odds ratio 3.28; CIs: 3.13-3.43). Some antibiotics (such as tetracyclines and metronidazole) seemed to confer greater risk than others. CONCLUSIONS The results lend support for prior antibiotics being an important risk factor for a diagnosis of FM. SIGNIFICANCE This study shows an association between the volume as well as timing of prior antibiotic prescriptions and of a subsequent diagnosis of fibromyalgia in primary care.
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Affiliation(s)
- David Armstrong
- Department of Population Health Sciences, King's College London, London, UK
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychological, and Neurosciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health Sciences, King's College London, London, UK
| | - Patrick White
- Department of Population Health Sciences, King's College London, London, UK
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Castaldo G, Marino C, Atteno M, D’Elia M, Pagano I, Grimaldi M, Conte A, Molettieri P, Santoro A, Napolitano E, Puca I, Raimondo M, Parisella C, D’Ursi AM, Rastrelli L. Investigating the Effectiveness of a Carb-Free Oloproteic Diet in Fibromyalgia Treatment. Nutrients 2024; 16:1620. [PMID: 38892552 PMCID: PMC11175073 DOI: 10.3390/nu16111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Fibromyalgia (FM), a chronic disease with a high incidence in women, poses a significant challenge for diagnosis and treatment, especially due to the absence of specific biomarkers and the multifaceted nature of its symptoms, which range from neuromuscular pain to mood disorders and intestinal dysbiosis. While diagnosis currently relies on rheumatological clinical evaluations and treatment options mainly focus on symptom management, FM seems to have possible links with systemic metabolic dysfunctions with a common inflammatory root. In this context, a new therapeutic avenue emerges: could a therapeutic nutritional approach be the missing piece of the puzzle? Indeed, diet therapies employed particularly for metabolic syndromes proved recently to be efficacious for correcting systemic dysmetabolism and a high number of chronic inflammation conditions. In particular, the very-low-calorie ketogenic diet (VLCKD) demonstrated therapeutic benefits in many disorders. In the present study, we aimed to investigate the specific effects of two dietary interventions, namely the oloproteic VLCKD and the low-glycemic insulinemic (LOGI) diet, on two groups of female FM patients (FM1 and FM2) over a 45-day period. Utilizing clinical and laboratory tests, as well as non-invasive NMR metabolomic analysis of serum, urine, and saliva samples, we sought to uncover how these dietary regimens impact the metabolic dysfunctions associated with FM.
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Affiliation(s)
- Giuseppe Castaldo
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Carmen Marino
- PhD Program in Drug Discovery and Development, Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (C.M.); (E.N.)
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (M.G.); (A.S.)
| | - Mariangela Atteno
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Maria D’Elia
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy;
- Department of Pharmacy, Scuola di Specializzazione in Farmacia Ospedaliera, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy
| | - Imma Pagano
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Manuela Grimaldi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (M.G.); (A.S.)
| | - Aurelio Conte
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Paola Molettieri
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Angelo Santoro
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (M.G.); (A.S.)
- Department of Pharmacy, Scuola di Specializzazione in Farmacia Ospedaliera, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy
| | - Enza Napolitano
- PhD Program in Drug Discovery and Development, Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (C.M.); (E.N.)
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (M.G.); (A.S.)
| | - Ilaria Puca
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Mariangela Raimondo
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Chiara Parisella
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
| | - Anna Maria D’Ursi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy; (M.G.); (A.S.)
| | - Luca Rastrelli
- NutriKeto_LAB Unisa—“San Giuseppe Moscati” National Hospital (AORN), Contrada Amoretta, 83100 Avellino, Italy (M.A.); (I.P.); (A.C.); (P.M.); (I.P.); (M.R.); (C.P.)
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy;
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Nhu NT, Chen DYT, Yang YCSH, Lo YC, Kang JH. Associations Between Brain-Gut Axis and Psychological Distress in Fibromyalgia: A Microbiota and Magnetic Resonance Imaging Study. THE JOURNAL OF PAIN 2024; 25:934-945. [PMID: 37866648 DOI: 10.1016/j.jpain.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
An altered brain-gut axis is suspected to be one of the pathomechanisms in fibromyalgia (FM). This cross-sectional study investigated the associations among altered microbiota, psychological distress, and brain functional connectivity (FC) in FM. We recruited 25 FM patients and 25 healthy people in the present study. Psychological distress was measured using standardized questionnaires. Microbiota analysis was performed on the participants' stools. Functional magnetic resonance imaging data were acquired, and seed-based resting-state FC (rs-FC) analysis was conducted with the salience network nodes as seeds. Linear regression and mediation analyses evaluated microbiota, symptoms, and rs-FCs associations. We found altered microbiota diversity in FM, of which Phascolarctobacterium and Lachnoclostridium taxa increased the most and Faecalibacterium taxon decreased the most compared to controls. The Phascolarctobacterium abundance significantly predicted Beck depression inventory (BDI-II) scores in FM (β = 6.83; P = .033). Rs-FCs from salience network nodes were reduced in FM, of which rs-FCs from the right lateral rostral prefrontal cortex (RPFC) to the lateral occipital cortex, superior division right (RPFC-sLOC) could be predicted by BDI-II scores in patients (β = -.0064; P = .0054). In addition, the BDI-II score was a mediator in the association between Phascolarctobacterium abundance and rs-FCs of RPFC-sLOC (ab = -.06; 95% CI: -.16 to -9.10-3). In conclusion, microbial dysbiosis might be associated with altered neural networks mediated by psychological distress in FM, emphasizing the critical role of the brain-gut axis in FM's non-pain symptoms and supporting further analysis of mechanism-targeted therapies to reduce FM symptoms. PERSPECTIVE: Our study suggests microbial dysbiosis might be associated with psychological distress and the altered salience network, supporting the role of brain-gut axis dysfunction in fibromyalgia pathomechanisms. Further targeting therapies for microbial dysbiosis should be investigated to manage fibromyalgia patients in the future.
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Affiliation(s)
- Nguyen Thanh Nhu
- International PhD program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - David Yen-Ting Chen
- Department of Medical Imaging, Taipei Medical University - Shuang-Ho Hospital, New Taipei City, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chen S H Yang
- Joint Biobank, Office of Human Research, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Lo
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- International PhD program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
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Al Sharie S, Varga SJ, Al-Husinat L, Sarzi-Puttini P, Araydah M, Bal’awi BR, Varrassi G. Unraveling the Complex Web of Fibromyalgia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:272. [PMID: 38399559 PMCID: PMC10890445 DOI: 10.3390/medicina60020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence transcending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. This study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. This study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia management. Overall, this study provides a nuanced and up-to-date overview of the complexities surrounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.
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Affiliation(s)
- Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Scott J. Varga
- Department of Neurology, OhioHealth Mansfield General Hospital, Mansfield, OH 44903, USA;
| | - Lou’i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, University School of Medicine, 20157 Milan, Italy;
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman 11942, Jordan;
| | - Batool Riyad Bal’awi
- Department of Family Medicine, Jordan Royal Medical Services, Amman 11855, Jordan;
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Wang Z, Jiang D, Zhang M, Teng Y, Huang Y. Causal association between gut microbiota and fibromyalgia: a Mendelian randomization study. Front Microbiol 2024; 14:1305361. [PMID: 38260871 PMCID: PMC10800605 DOI: 10.3389/fmicb.2023.1305361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background Fibromyalgia (FM) is a syndrome characterized by chronic and widespread musculoskeletal pain. A number of studies have implied a potential association between gut microbiota and FM. However, the casual association between gut microbiota and FM remains unknown. Method Mendelian randomization (MR) study was conducted using the summary statistics of genetic variants from the genome-wide association study (GWAS). Inverse variance weighted (IVW), combined with MR-Egger and weighted median were used to investigate the causal association between 119 gut microbiota genera and FM. Sensitivity analyses were performed on the MR results, including heterogeneity test, leave-one-out test and pleiotropy test. Results A total of 1,295 single nucleotide polymorphism (SNPs) were selected as instrumental variables (IVs), with no significant heterogeneity and pleiotropy according to the sensitivity analyses. Five gut microbiota genera were found to have significant casual association with FM. Coprococcus2 (OR = 2.317, p-value = 0.005, 95% CI: 1.289-4.167), Eggerthella (OR = 1.897, p-value = 0.001, 95% CI: 1.313-2.741) and Lactobacillus (OR = 1.576, p-value =0.020, 95% CI: 1.073-2.315) can increase the risk of FM. FamillyXIIIUCG001 (OR = 0.528, p-value = 0.038, 95% CI: 0.289-0.964) and Olsenella (OR = 0.747, p-value = 0.050, 95% CI: 0.557-1.000) can decrease the risk of FM. Conclusion This MR study found that gut microbiota is casually associated with FM. New insights into the mechanisms of FM mediated by gut microbiota are provided.
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Affiliation(s)
- Zhaohua Wang
- Beijing Engineering Research Center of Food Environment and Public Health, Minzu University of China, Beijing, China
- College of life and Environmental Science, Minzu University of China, Beijing, China
| | - Dan Jiang
- College of Food Science and Engineering, Dalian Ocean University, Dalian, China
| | - Min Zhang
- Beijing Engineering Research Center of Food Environment and Public Health, Minzu University of China, Beijing, China
- College of life and Environmental Science, Minzu University of China, Beijing, China
| | - Yu Teng
- Beijing Engineering Research Center of Food Environment and Public Health, Minzu University of China, Beijing, China
- College of life and Environmental Science, Minzu University of China, Beijing, China
| | - Yaojiang Huang
- Beijing Engineering Research Center of Food Environment and Public Health, Minzu University of China, Beijing, China
- College of life and Environmental Science, Minzu University of China, Beijing, China
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Palma-Ordóñez JF, Moreno-Fernández AM, Ramírez-Tejero JA, Durán-González E, Martínez-Lara A, Cotán D. Implication of intestinal microbiota in the etiopathogenesis of fibromyalgia: A systematic review. Int J Rheum Dis 2024; 27:e15021. [PMID: 38287551 DOI: 10.1111/1756-185x.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/18/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
Fibromyalgia (FM) is a highly prevalent chronic disease. About 4.7% of the world's population suffers from generalized pain and hypersensitivity, in addition to a wide range of physical and psychological symptoms. The etiopathogenesis of this disease is multifactorial, which makes its diagnosis and treatment challenging. Recently, the increase in the number of studies on microbiota has provided new data that can help to understand the onset and development of FM. An updated systematic review of the causes of FM has been carried out in this work. Particularly in the last decade, research has focused on the gut-brain axis, which has emerged as a crucial mechanism for microbiota-host crosstalk. In FM patients, quantitative imbalances of the intestinal microbiota (dysbiosis) and bacterial metabolites with differential relative abundance have been found, especially short-chain fatty acids and lipopolysaccharides. Furthermore, the microbiota has been found to indirectly influence host neurotransmitter mechanisms, mainly through the serotonin precursor, glutamate, and gamma-aminobutyric acid. Thus, all these mechanisms and their influence on the etiopathogenesis of FM are discussed in this review.
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del Amo LL, Durán-González E, Ramírez-Tejero JA, Martínez-Lara A, Cotán D. Study protocol for FIBROKIT: a new tool for fibromyalgia diagnosis and patient follow-up. Front Neurol 2023; 14:1286539. [PMID: 38073622 PMCID: PMC10710143 DOI: 10.3389/fneur.2023.1286539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 02/27/2024] Open
Abstract
Fibromyalgia (FM) is a complex disease that is characterized by chronic musculoskeletal pain and has great economic impact. FM prevalence is about 2% to 4% worldwide, affecting mainly middle-aged women, and its complex pathophysiology complicates diagnosis, treatment and the findings of solid biomarkers. Previous studies have suggested an association between the disease and oxidative stress, mitochondrial metabolism, intestinal microbiota and inflammation, providing sufficient data to support the multifactorial origin of FM. Hence, the objective of this randomized, prospective, low-interventional, double-blinded and placebo-controlled clinical trial is the development of a specific panel of FM biomarkers and the evaluation of their response to a six-month nutritional intervention based on the Mediterranean diet supplemented with extra virgin olive oil (EVOO). For this purpose, the experimental design implies the recruitment of a large cohort of female Spanish patients. Middle-aged women who meet the diagnostic criteria for FM according to the American College of Rheumatology (ACR) will be eligible, along with age-matched healthy women. Both groups will be randomly divided into placebo (olive oil, OO) and treatment groups (extra virgin olive oil, EVOO), and will provide samples at the beginning (T0), after 3 months of nutritional intervention (T1), at the end of the nutritional intervention in 6 months (T2), and 6 months after the end of nutritional intervention (TF), being enrolled for 1 year. Data will be collected through health questionnaires, and whole blood and stool samples will be taken and analyzed. Blood will be used for western-blotting and proteomic analysis of mitochondrial homeostasis and plasma proteome, while stool will undergo metagenomic analysis, respectively. This study represents the first low-interventional investigation with more than 200 participants focused on exploring the association of oxidative stress, mitochondrial metabolism, intestinal microbiota and related pathways with a nutritional intervention in the context of FM. As a result, the outcomes of this study will significantly contribute to the development of a comprehensive and robust panel of diagnostic biomarkers, and will shed some light on their modulation with non-pharmacological therapies such as nutrition. Clinical trial registration: https://clinicaltrials.gov/study/NCT05921409, identifier: NCT05921409.
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Párraga JP, Castellanos A. A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience. J Clin Med 2023; 12:7080. [PMID: 38002692 PMCID: PMC10672144 DOI: 10.3390/jcm12227080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards non-pharmacological treatments, such as therapeutic education, exercise, and cognitive-behavioral therapy. With the advent of cognitive neuroscience, pain is often presented as a primary output derived from the brain, aligning with Engel's Biopsychosocial Model that views disease not solely from a biological perspective but also considering psychological and social factors. This paradigm shift brings forward potential misconceptions and over-simplifications. The current review delves into the intricacies of nociception and pain perception. It questions long-standing beliefs like the cerebral-centric view of pain, the forgotten role of the peripheral nervous system in pain chronification, misconceptions around central sensitization syndromes, the controversy about the existence of a dedicated pain neuromatrix, the consciousness of the pain experience, and the possible oversight of factors beyond the nervous system. In re-evaluating these aspects, the review emphasizes the critical need for understanding the complexity of pain, urging the scientific and clinical community to move beyond reductionist perspectives and consider the multifaceted nature of this phenomenon.
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Affiliation(s)
- Javier Picañol Párraga
- Laboratory of Neurophysiology, Biomedicine Department, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08036 Barcelona, Spain
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Okutan G, Sánchez Niño GM, Terrén Lora A, López Oliva S, San Mauro Martín I. Exogenous Supplementation with DAO Enzyme in Women with Fibromyalgia: A Double-Blind Placebo-Controlled Clinical Trial. J Clin Med 2023; 12:6449. [PMID: 37892588 PMCID: PMC10607251 DOI: 10.3390/jcm12206449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Fibromyalgia (FM) is characterized by chronic musculoskeletal pain, muscle tension, joint mobility loss, and several psychological symptoms severely affecting patient well-being. Histamine is naturally degraded in the small intestine by diamine oxidase (DAO). Hereditary or acquired DAO deficiency causes extracellular histamine accumulation, leading to symptoms similar to those of individuals diagnosed with FM. Thus, this study aimed to assess the efficacy of adding DAO supplementation for 8 weeks to their standard therapy. We randomly assigned 100 women with FM (age: 33-61 years) to the supplementation and control groups. The Fibromyalgia Impact Questionnaire (FIQ), the Pain Catastrophizing Scale (PCS), and intensity scales were applied for a series of clinical symptoms together with the Bristol scale to assess the added value of DAO supplementation. Patients in both groups were receiving complete pharmacological support but some differences in the number of subjects receiving analgesics, antidepressants, and anxiolytics was noted. Patients in both study groups experienced favorable changes during the evaluation period as indicated by their final FIQ and PCS scores, particularly in the DAO group in the latter questionnaire. Qualitatively, the patients assigned to the DAO treatment group had lower scores for fatigue, anxiety, depression, burning and for rumination, magnification, and helplessness.
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Affiliation(s)
| | | | | | | | - Ismael San Mauro Martín
- Research Centers in Nutrition and Health (CINUSA Group), Paseo de la Habana 43, 28036 Madrid, Spain; (G.O.); (G.M.S.N.); (A.T.L.); (S.L.O.)
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Martín F, Blanco-Suárez M, Zambrano P, Cáceres O, Almirall M, Alegre-Martín J, Lobo B, González-Castro AM, Santos J, Domingo JC, Jurek J, Castro-Marrero J. Increased gut permeability and bacterial translocation are associated with fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome: implications for disease-related biomarker discovery. Front Immunol 2023; 14:1253121. [PMID: 37744357 PMCID: PMC10512706 DOI: 10.3389/fimmu.2023.1253121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background There is growing evidence of the significance of gastrointestinal complaints in the impairment of the intestinal mucosal barrier function and inflammation in fibromyalgia (FM) and in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, data on intestinal permeability and gut barrier dysfunction in FM and ME/CFS are still limited with conflicting results. This study aimed to assess circulating biomarkers potentially related to intestinal barrier dysfunction and bacterial translocation and their association with self-reported symptoms in these conditions. Methods A pilot multicenter, cross-sectional cohort study with consecutive enrolment of 22 patients with FM, 30 with ME/CFS and 26 matched healthy controls. Plasma levels of anti-beta-lactoglobulin antibodies (IgG anti-β-LGB), zonulin-1 (ZO-1), lipopolysaccharides (LPS), soluble CD14 (sCD14) and interleukin-1-beta (IL-1β) were assayed using ELISA. Demographic and clinical characteristics of the participants were recorded using validated self-reported outcome measures. The diagnostic accuracy of each biomarker was assessed using the receiver operating characteristic (ROC) curve analysis. Results FM patients had significantly higher levels of anti-β-LGB, ZO-1, LPS, and sCD14 than healthy controls (all P < 0.0001). In ME/CFS patients, levels of anti-β-LGB, ZO-1, LPS, and sCD14 were significantly higher than controls, but lower than in FM (all P < 0.01), while there was no significant difference in IL-1β level. In the FM and ME/CFS cohorts, both anti-β-LGB and ZO-1 correlated significantly with LPS and sCD14 (P < 0.001 for both). In the FM group, both anti-β-LGB and ZO-1 were correlated significantly with physical and mental health components on the SF-36 scale (P < 0.05); whereas IL-1β negatively correlated with the COMPASS-31 score (P < 0.05). In the ME/CFS cohort, ZO-1 was positively correlated with the COMPASS-31 score (P < 0.05). The ROC curve analysis indicated a strong ability of anti-β-LGB, ZO-1, LPS and sCD14 to predictively distinguish between FM and ME/CFS from healthy controls (P < 0.0001). Conclusion Biomarkers of intestinal barrier function and inflammation were associated with autonomic dysfunction assessed by COMPASS-31 scores in FM and ME/CFS respectively. Anti-β-LGB antibodies, ZO-1, LPS, and sCD14 may be putative predictors of intestinal barrier dysfunction in these cohorts. Further studies are needed to assess whether these findings are causal and can therefore be applied in clinical practice.
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Affiliation(s)
- Franz Martín
- Andalusian Centre of Molecular Biology and Regenerative Medicine (CABIMER), University Pablo Olavide, University of Seville, Seville, Spain
- Biomedical Research Network on Diabetes and Related Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Blanco-Suárez
- Central Sensitivity Unit (SHC Medical), Hospital Viamed Santa Ángela de la Cruz, Seville, Spain
| | - Paola Zambrano
- Central Sensitivity Unit (SHC Medical), Hospital Viamed Santa Ángela de la Cruz, Seville, Spain
| | - Oscar Cáceres
- Central Sensitivity Unit (SHC Medical), Hospital Viamed Santa Ángela de la Cruz, Seville, Spain
| | - Miriam Almirall
- Division of Rheumatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Rheumatology Research Group, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Research Unit, Vall d´Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Alegre-Martín
- Division of Rheumatology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Rheumatology Research Group, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Research Unit, Vall d´Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Lobo
- Laboratory of Neuro-Immuno-Gastroenterology, Digestive System Research Unit, Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Maria González-Castro
- Laboratory of Neuro-Immuno-Gastroenterology, Digestive System Research Unit, Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Santos
- Laboratory of Neuro-Immuno-Gastroenterology, Digestive System Research Unit, Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Carles Domingo
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Joanna Jurek
- Rheumatology Research Group, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Research Unit, Vall d´Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Castro-Marrero
- Rheumatology Research Group, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Research Unit, Vall d´Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pontes-Silva A, Nunes I, De Miguel-Rubio A, de Souza MC, DeSantana JM, Avila MA. Social variables for replication of studies using mean scores of social support, self-care, and fibromyalgia knowledge: a cross-sectional study. Rheumatol Int 2023; 43:1705-1721. [PMID: 37335339 DOI: 10.1007/s00296-023-05374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
To investigate biopsychosocial variables that contribute to explaining social support, self-care, and fibromyalgia knowledge in patients with fibromyalgia. A cross-sectional study. We built ten models of predictive variables (schooling, ethnicity, associated diseases, body regions affected by pain, employment status, monthly income, marital status, health level, medication, sports activities, interpersonal relationships, nutrition level, widespread pain, symptom severity, cohabitation, dependent people, number of children, social support, self-care, and fibromyalgia knowledge) and individually tested their explanatory performance to predict mean scores on the Fibromyalgia Knowledge Questionnaire (FKQ), Medical Outcomes Study's Social Support Scale (MOS-SSS), and Appraisal of Self-Care Agency Scale-Revised (ASAS-R). We used analysis of variance to verify the association among all variables of mathematically adjusted models (F-value ≥ 2.20) and we reported only models corrected with p < 0.05 and R2 > 0.20. One hundred and ninety people with fibromyalgia (aged 42.3 ± 9.7 years) participated in the study. Our results show that the variables schooling, ethnicity, body regions affected by pain, frequency of sports activities, dependent people, number of children, widespread pain, social support, and self-care determine 27% of the mean FKQ scores. Marital status, self-care, and fibromyalgia knowledge determine 22% of mean MOS-SSS scores. Schooling, ethnicity, employment status, frequency of sports activities, nutrition level, cohabitation, number of children, social support, and fibromyalgia knowledge determine 30% of the mean ASAS-R scores. Studies using mean scores of social support, self-care, and fibromyalgia knowledge should collect and analyze the social variables described in the present study.
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Affiliation(s)
- André Pontes-Silva
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | - Isadora Nunes
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | | | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Josimari Melo DeSantana
- Department of Physical Therapy, Graduate Program in Health Science and Graduate Program in Physiological Science, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.
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12
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Favretti M, Iannuccelli C, Di Franco M. Pain Biomarkers in Fibromyalgia Syndrome: Current Understanding and Future Directions. Int J Mol Sci 2023; 24:10443. [PMID: 37445618 DOI: 10.3390/ijms241310443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Fibromyalgia is a complex and heterogeneous clinical syndrome, mainly characterized by the presence of widespread pain, possibly associated with a variety of other symptoms. Fibromyalgia can have an extremely negative impact on the psychological, physical and social lives of people affected, sometimes causing patients to experience dramatically impaired quality of life. Nowadays, the diagnosis of fibromyalgia is still clinical, thus favoring diagnostic uncertainties and making its clear identification challenging to establish, especially in primary care centers. These difficulties lead patients to undergo innumerable clinical visits, investigations and specialist consultations, thus increasing their stress, frustration and even dissatisfaction. Unfortunately, research over the last 25 years regarding a specific biomarker for the diagnosis of fibromyalgia has been fruitless. The discovery of a reliable biomarker for fibromyalgia syndrome would be a critical step towards the early identification of this condition, not only reducing patient healthcare utilization and diagnostic test execution but also providing early intervention with guideline-based treatments. This narrative article reviews different metabolite alterations proposed as possible biomarkers for fibromyalgia, focusing on their associations with clinical evidence of pain, and highlights some new, promising areas of research in this context. Nevertheless, none of the analyzed metabolites emerge as sufficiently reliable to be validated as a diagnostic biomarker. Given the complexity of this syndrome, in the future, a panel of biomarkers, including subtype-specific biomarkers, could be considered as an interesting alternative research area.
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Affiliation(s)
- Martina Favretti
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Iannuccelli
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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13
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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14
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Erdrich S, Hawrelak JA, Myers SP, Vuyisich M, Harnett JE. Investigating the association between the symptoms of women with Fibromyalgia, Digestive function, and markers of the microbiota of the Gastrointestinal Tract (The FIDGIT Study): study protocol. BMC Musculoskelet Disord 2023; 24:150. [PMID: 36849949 PMCID: PMC9969038 DOI: 10.1186/s12891-023-06259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Fibromyalgia a common idiopathic condition affecting around 1.4% of adults globally. Its signature symptom is chronic widespread pain, with a constellation of somatic and psychological symptoms. Fibromyalgia is associated with significant reductions in quality of life, yet to date there is no biochemical marker for its diagnosis. Previous studies have indicated a strong association with gastrointestinal dysfunction, and more recently, alterations to the gut microbiome. No studies have examined the inter-relationship between fibromyalgia, gastrointestinal dysfunction, and the microbiome. This prospective observational case-controlled study will gather data on gastrointestinal function, dietary intake, fermentation patterns of ingested carbohydrates, and symptoms commonly associated with fibromyalgia. These will be evaluated alongside human gene expression and metatranscriptomic analysis of the oral and faecal microbiome. METHODS Adult women aged ≥18 years diagnosed with fibromyalgia and/or meeting ACR 2016 criteria, and healthy family or age-matched controls will be recruited from the community. From consenting participants, we will collect detailed survey information and samples of blood, urine, stool, saliva, and breath. DISCUSSION This is the first prospective study examining interactions between digestive function, human gene expression, and the gut microbiome together with general, and fibromyalgia-specific, symptoms experienced by New Zealand women. This exploration will allow an in-depth understanding of clinically relevant factors that are associated with fibromyalgia and will guide further research and contribute to improved management of this poorly understood condition. TRIAL REGISTRATION The study was approved by the New Zealand Health and Disability Committee (HDEC) (ref: 20/CEN/197) and registered with the Australia and New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12620001337965. Written consent will be obtained after providing participants with detailed information about the procedures. Access to data will be restricted to the immediate research team, and all samples and survey data will be deidentified and coded before analysis.
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Affiliation(s)
- Sharon Erdrich
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
| | - Jason A Hawrelak
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen P Myers
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
- NatMed Research, Evans Head, New South Wales, Australia
| | - Momchilo Vuyisich
- Viome Life Sciences Inc, Seattle, Washington, United States of America
| | - Joanna E Harnett
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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15
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Piras C, Pibiri M, Conte S, Ferranti G, Leoni VP, Liggi S, Spada M, Muntoni S, Caboni P, Atzori L. Metabolomics analysis of plasma samples of patients with fibromyalgia and electromagnetic sensitivity using GC-MS technique. Sci Rep 2022; 12:21923. [PMID: 36535959 PMCID: PMC9763344 DOI: 10.1038/s41598-022-25588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Fibromyalgia (FM) is a chronic and systemic condition that causes widespread chronic pain, asthenia, and muscle stiffness, as well as in some cases depression, anxiety, and disorders of the autonomic system. The exact causes that lead to the development of FM are still unknown today. In a percentage of individuals, the symptoms of FM are often triggered and/or exacerbated by proximity to electrical and electromagnetic devices. Plasma metabolomic profile of 54 patients with fibromyalgia and self-reported electromagnetic sensitivity (IEI-EMF) were compared to 23 healthy subjects using gas chromatography-mass spectrometry (GC-MS) coupled with multivariate statistical analysis techniques. Before the GC-MS analysis the plasma samples were extracted with a modified Folch method and then derivatized with methoxamine hydrochloride in pyridine solution and N-trimethylsilyltrifuoroacetamide. The combined analysis allowed to identify a metabolomic profile able of distinguishing IEI-EMF patients and healthy subjects. IEI-EMF patients were therefore characterized by the alteration of 19 metabolites involved in different metabolic pathways such as energy metabolism, muscle, and pathways related to oxidative stress defense and chronic pain. The results obtained in this study complete the metabolomic "picture" previously investigated on the same cohort of IEI-EMF patients with 1H-NMR spectroscopy, placing a further piece for better understanding the pathophysiological mechanisms in patients with IEI-EMF.
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Affiliation(s)
- Cristina Piras
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Monica Pibiri
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Stella Conte
- grid.7763.50000 0004 1755 3242Department of Education, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Gabriella Ferranti
- grid.7763.50000 0004 1755 3242Department of Education, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Vera Piera Leoni
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Sonia Liggi
- grid.7445.20000 0001 2113 8111Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Martina Spada
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Sandro Muntoni
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
| | - Pierluigi Caboni
- grid.7763.50000 0004 1755 3242Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Atzori
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Clinical Metabolomics Unit, University of Cagliari, Blocco A, Cittadella Universitaria, Monserrato, CA Italy
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Microbiota-Pain Association; Recent Discoveries and Research Progress. Curr Microbiol 2022; 80:29. [PMID: 36474077 DOI: 10.1007/s00284-022-03124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
The relationship between gut microbiota and pain, such as visceral pain, headaches (migraine), itching, prosthetic joint infection (PJI), chronic abdominal pain (CAP), joint pain, etc., has received increasing attention. Several parts of the evidence suggest that microbiota is one of the most important pain modulators and they can regulate pain in the central and peripheral nervous systems. Any alteration in microbiota by diet or antibiotics mediation may characterize a novel therapeutic strategy for pain management. The present study includes the most up-to-date and influential scientific findings on the association of microbiota with pain, despite the fact that the underlying mechanism is not identified in most cases. According to recent research, identifying the molecular mechanisms of the microbiota-pain pathway can have a unique perspective in treating many diseases, even though there is a long way to reach the ideal point. This study will stress the influence of microbiota on the common diseases that can stimulate the pain with a focus on underlying mechanisms.
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Abstract
The pathogenesis of irritable bowel syndrome (IBS)-a disorder of gut-brain interaction that affects up to 10% of the world's population-remains uncertain. It is puzzling that a disorder so prevalent and archetypal among humans can be explained by disparate theories, respond to treatments with vastly different mechanisms of action, and present with a dazzling array of comorbidities. It is reasonable to question whether there is a unifying factor that binds these divergent theories and observations, and if so, what that factor might be. This article offers a testable hypothesis that seeks to accommodate the manifold theories, clinical symptoms, somatic comorbidities, neuropsychological features, and treatment outcomes of IBS by describing the syndrome in relation to a principal force of human evolution: gravity. In short, the hypothesis proposed here is that IBS may result from ineffective anatomical, physiological, and neuropsychological gravity management systems designed to optimize gastrointestinal form and function, protect somatic and visceral integrity, and maximize survival in a gravity-bound world. To explain this unconventional hypothesis of IBS pathogenesis, referred to herein as the gravity hypothesis, this article reviews the influence of gravity on human evolution; discusses how Homo sapiens imperfectly evolved to manage this universal force of attraction; and explores the mechanical, microbial, and neuropsychological consequences of gravity intolerance with a focus on explaining IBS. This article concludes by considering the diagnostic and therapeutic implications of this new hypothesis and proposes experiments to support or reject this line of inquiry. It is hoped that the ideas in this thought experiment may also help encourage new or different ways of thinking about this common disorder.
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18
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Zhou C, Li J, Guo C, Zhou Z, Yang Z, Zhang Y, Jiang J, Cai Y, Zhou J, Ming Y. Comparison of intestinal flora between patients with chronic and advanced Schistosoma japonicum infection. Parasit Vectors 2022; 15:413. [PMID: 36345042 PMCID: PMC9640844 DOI: 10.1186/s13071-022-05539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background Schistosoma japonicum infection is an important public health problem, imposing heavy social and economic burdens in 78 countries worldwide. However, the mechanism of transition from chronic to advanced S. japonicum infection remains largely unknown. Evidences suggested that gut microbiota plays a role in the pathogenesis of S. japonicum infection. However, the composition of the gut microbiota in patients with chronic and advanced S. japonicum infection is not well defined. In this study, we compared the composition of the intestinal flora in patients with chronic and advanced S. japonicum infection. Methods The feces of 24 patients with chronic S. japonicum infection and five patients with advanced S. japonicum infection from the same area were collected according to standard procedures, and 16S rRNA sequencing technology was used to analyze the intestinal microbial composition of the two groups of patients. Results We found that alteration occurs in the gut microbiota between the groups of patients with chronic and advanced S. japonicum infections. Analysis of alpha and beta diversity indicated that the diversity and abundance of intestinal flora in patients with advanced S. japonicum infection were lower than those in patients with chronic S. japonicum infection. Furthermore, Prevotella 9, Subdoligranulum, Ruminococcus torques, Megamonas and Fusicatenibacter seemed to have potential to discriminate different stages of S. japonicum infection and to act as biomarkers for diagnosis. Function prediction analysis revealed that microbiota function in the chronic group was focused on translation and cell growth and death, while that in the advanced group was concentrated on elevating metabolism-related functions. Conclusions Our study demonstrated that alteration in gut microbiota in different stages of S. japonicum infection plays a potential role in the pathogenesis of transition from chronic to advanced S. japonicum infection. However, further validation in the clinic is needed, and the underlying mechanism requires further study. Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05539-6.
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Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies. Healthcare (Basel) 2022; 10:healthcare10101975. [PMID: 36292422 PMCID: PMC9602604 DOI: 10.3390/healthcare10101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Fibromyalgia (FM) is a chronic pain syndrome with an unclear etiology. In addition to pain, FM patients suffer from a diverse array of symptoms and comorbidities, encompassing fatigue, cognitive dysfunction, mood disorders, sleep deprivation, and dizziness. Due to the complexity of FM, the diagnosis and treatment of it are highly challenging. The aim of the present work was to investigate some clinical and psychological characteristics of FM patients, and to uncover possible correlations with pharmacological and non-pharmacological therapies. We conducted a cross-sectional, questionnaire-based study aimed at evaluating pain, psychological traits, and the self-perceived effectiveness of pharmacological and non-pharmacological treatments in an Italian population of FM patients. Descriptive statistics, correlation, and inference analyses were performed. We found a prevalence of a neuropathic/nociplastic type of pain, which correlated with psychological traits such as anxiety, low mood, psychophysical discomfort, and the inability to relax. The pain type and psychological traits proved to play a role in determining the self-perceived effectiveness of therapeutic interventions. Patients revealed a better response to non-pharmacological therapies, particularly dietary interventions, relaxation techniques, and psychotherapy rather than pharmacological interventions. The sum of our data indicates that for better outcomes, the type of pain and psychological traits should be considered for tailor-made treatments considering non-pharmacological protocols as a complement to the use of drugs.
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Weber T, Tatzl E, Kashofer K, Holter M, Trajanoski S, Berghold A, Heinemann A, Holzer P, Herbert MK. Fibromyalgia-associated hyperalgesia is related to psychopathological alterations but not to gut microbiome changes. PLoS One 2022; 17:e0274026. [PMID: 36149895 PMCID: PMC9506607 DOI: 10.1371/journal.pone.0274026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Abstract
Fibromyalgia-syndrome (FMS) is a complex disease characterized by chronic widespread pain and additional symptoms including depression, cognitive dysfunction ("fibro-fog") and maldigestion. Our research team examined whether FMS-related pain parameters assessed by quantitative sensory testing (QST) and psychological disturbances are accompanied by alterations of the fecal microbiome. We recruited 25 patients with FMS and 26 age- and sex-matched healthy controls. Medical background, food habits, psychopathology and quality of life were assessed through questionnaires. Stool samples were analyzed by 16S rRNA gene amplification and sequencing. QST was performed according to the protocol of the German Network for Neuropathic Pain. QST showed that both lemniscal and spinothalamic afferent pathways are altered in FMS patients relative to healthy controls and that peripheral as well as central pain sensitization processes are manifest. Psychometric assessment revealed enhanced scores of depression, anxiety and stress. In contrast, neither the composition nor the alpha- and beta-diversity of the fecal microbiome was changed in FMS patients. FMS patients segregate from healthy controls in various parameters of QST and psychopathology, but not in terms of composition and diversity of the fecal microbiome. Despite consideration of several confounding factors, we conclude that the contribution of the gut microbiome to the pathophysiology of FMS is limited.
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Affiliation(s)
- Thomas Weber
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Eva Tatzl
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Karl Kashofer
- Diagnostic & Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Magdalena Holter
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Slave Trajanoski
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Akos Heinemann
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Peter Holzer
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Michael Karl Herbert
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Navarro-Ledesma S, Pruimboom L, Lluch E, Dueñas L, Mena-Del Horno S, Gonzalez-Muñoz A. The Relationship between Daily Physical Activity, Psychological Factors, and Vegetative Symptoms in Women with Fibromyalgia: A Cross-Sectional Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11610. [PMID: 36141882 PMCID: PMC9517117 DOI: 10.3390/ijerph191811610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 05/27/2023]
Abstract
Nowadays, there is evidence that relates the amount of physical activity, as well as the impact of psychological factors, to the intensity of symptoms present in patients with fibromyalgia (FM). However, there are no studies which correlate the level of association of physical activity, psychological factors and vegetative symptoms in the FM population. The study has a cross-sectional observational design with 41 participants being recruited from a private clinic and rehabilitation service. The Autonomic Symptom Profile (Compass-31) to assess vegetative symptoms, the GODIN questionnaire to evaluate the level of leisure activity, and the pain catastrophizing scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale to assess psychological factors, were used. A low and significant level of association was found between pain catastrophizing (PCS) and Kinesiophobia (r = 0.398; p < 0.01), as well as with catastrophizing and vegetative symptoms (r = 0.428; p < 0.05). Furthermore, a low and significant level of association was also found between self-efficacy and vegetative symptoms (r = 0.397; p < 0.05). No association was found between the level of daily physical activity (measured by the Godin Leisure questionnaire) and vegetative symptoms, nor with any psychological factor studied. There is an association between vegetative symptoms and psychological factors. Nevertheless, more research which takes other factors into account, such as lifestyle and nutritional, is needed.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street 5, 52004 Melilla, Spain
- University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Querol Street 5, 52004 Melilla, Spain
- PNI Europe, 2518 JP The Hague, The Netherlands
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Querol Street 5, 52004 Melilla, Spain
- PNI Europe, 2518 JP The Hague, The Netherlands
| | - Enrique Lluch
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Pain in Motion International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Lirios Dueñas
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Silvia Mena-Del Horno
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Street de Gascó Oliag, 5, 46010 Valencia, Spain
| | - Ana Gonzalez-Muñoz
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
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22
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Silva AR, Bernardo A, de Mesquita MF, Vaz-Patto J, Moreira P, Silva ML, Padrão P. An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial. Front Nutr 2022; 9:856216. [PMID: 36091254 PMCID: PMC9450131 DOI: 10.3389/fnut.2022.856216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM.ObjectiveTo evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM.MethodsThis two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann−Whitney were used to compare variables between groups.ResultsAfter intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention.ConclusionAn anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].
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Affiliation(s)
- Ana Rita Silva
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
- *Correspondence: Ana Rita Silva,
| | - Alexandra Bernardo
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
| | - Maria Fernanda de Mesquita
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
| | | | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Maria Leonor Silva
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
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Unlocking the Potential of the Human Microbiome for Identifying Disease Diagnostic Biomarkers. Diagnostics (Basel) 2022; 12:diagnostics12071742. [PMID: 35885645 PMCID: PMC9315466 DOI: 10.3390/diagnostics12071742] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023] Open
Abstract
The human microbiome encodes more than three million genes, outnumbering human genes by more than 100 times, while microbial cells in the human microbiota outnumber human cells by 10 times. Thus, the human microbiota and related microbiome constitute a vast source for identifying disease biomarkers and therapeutic drug targets. Herein, we review the evidence backing the exploitation of the human microbiome for identifying diagnostic biomarkers for human disease. We describe the importance of the human microbiome in health and disease and detail the use of the human microbiome and microbiota metabolites as potential diagnostic biomarkers for multiple diseases, including cancer, as well as inflammatory, neurological, and metabolic diseases. Thus, the human microbiota has enormous potential to pave the road for a new era in biomarker research for diagnostic and therapeutic purposes. The scientific community needs to collaborate to overcome current challenges in microbiome research concerning the lack of standardization of research methods and the lack of understanding of causal relationships between microbiota and human disease.
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Wang Y, Wei J, Zhang W, Doherty M, Zhang Y, Xie H, Li W, Wang N, Lei G, Zeng C. Gut dysbiosis in rheumatic diseases: A systematic review and meta-analysis of 92 observational studies. EBioMedicine 2022; 80:104055. [PMID: 35594658 PMCID: PMC9120231 DOI: 10.1016/j.ebiom.2022.104055] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022] Open
Abstract
Background Emerging evidence suggests that dysbiosis in gut microbiota may contribute to the occurrence or development of several rheumatic diseases. Since gut microbiota dysbiosis is potentially modifiable, it has been postulated to be a promising preventive or therapeutic target for rheumatic diseases. However, the current understanding on the potential associations between gut microbiota and rheumatic diseases is still inadequate. Therefore, we aimed to synthesise the accumulating evidence for the relation of gut microbiota to rheumatic diseases. Methods The PubMed, Embase and Cochrane Library were searched from inception to March 11, 2022 to include observational studies evaluating the associations between gut microbiota and rheumatic diseases. Standardised mean difference (SMD) of α-diversity indices between rheumatic diseases and controls were estimated using random-effects model. β-diversity indices and relative abundance of gut microbes were summarised qualitatively. Findings Of the included 92 studies (11,998 participants), 68 provided data for α-diversity. Taken together as a whole, decreases in α-diversity indices were consistently found in rheumatic diseases (observed species: SMD = −0.36, [95%CI = −0.63, −0.09]; Chao1: SMD = −0.57, [95%CI = −0.88, −0.26]; Shannon index: SMD = −0.33, [95%CI = −0.48, −0.17]; Simpson index: SMD = −0.32, [95%CI = −0.49, −0.14]). However, when specific rheumatic diseases were examined, decreases were only observed in rheumatoid arthritis (observed species: SMD = −0.51, [95%CI = −0.78, −0.24]; Shannon index: SMD = −0.31, [95%CI = −0.49, −0.13]; Simpson index: SMD = −0.31, [95%CI = −0.54, −0.08]), systemic lupus erythematosus (Chao1: SMD = −1.60, [95%CI = −2.54, −0.66]; Shannon index: SMD = −0.63, [95%CI = −1.08, −0.18]), gout (Simpson index: SMD = −0.64, [95%CI = −1.07, −0.22]) and fibromyalgia (Simpson index: SMD = −0.28, [95%CI = −0.44, −0.11]), whereas an increase was observed in systemic sclerosis (Shannon index: SMD = 1.25, [95%CI = 0.09, 2.41]). Differences with statistical significance in β-diversity were consistently reported in ankylosing spondylitis and IgG4-related diseases. Although little evidence of disease specificity of gut microbes was found, shared alterations of the depletion of anti-inflammatory butyrate-producing microbe (i.e., Faecalibacterium) and the enrichment of pro-inflammatory microbe (i.e., Streptococcus) were observed in rheumatoid arthritis, Sjögren's syndrome and systemic lupus erythematosus. Interpretation Gut microbiota dysbiosis was associated with rheumatic diseases, principally with potentially non-specific, shared alterations of microbes. Funding National Natural Science Foundation of China (81930071, 81902265, 82072502 and U21A20352).
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Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Weiya Zhang
- University of Nottingham, Nottingham, UK; Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Michael Doherty
- University of Nottingham, Nottingham, UK; Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Haibin Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Wei Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Ning Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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26
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Baldi S, Pagliai G, Dinu M, Di Gloria L, Nannini G, Curini L, Pallecchi M, Russo E, Niccolai E, Danza G, Benedettelli S, Ballerini G, Colombini B, Bartolucci G, Ramazzotti M, Sofi F, Amedei A. Effect of ancient Khorasan wheat on gut microbiota, inflammation, and short-chain fatty acid production in patients with fibromyalgia. World J Gastroenterol 2022; 28:1965-1980. [PMID: 35664958 PMCID: PMC9150053 DOI: 10.3748/wjg.v28.i18.1965] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/19/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) syndrome is mainly characterized by widespread pain, sleeping disorders, fatigue, and cognitive dysfunction. In many cases, gastrointestinal distress is also reported, suggesting the potential pathogenic role of the gut microbiota (GM). The GM is deeply influenced by several environmental factors, especially the diet, and recent findings highlighted significant symptom improvement in FM patients following various nutritional interventions such as vegetarian diet, low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols based diets, gluten-free diet, and especially an ancient grain supplementation. In particular, a recent study reported that a replacement diet with ancient Khorasan wheat led to an overall improvement in symptom severity of FM patients.
AIM To examine the effects of ancient Khorasan wheat on the GM, inflammation, and short-chain fatty acid production in FM patients.
METHODS After a 2-wk run-in period, 20 FM patients were enrolled in this randomized, double-blind crossover trial. In detail, they were assigned to consume either Khorasan or control wheat products for 8 wk and then, following an 8-wk washout period, crossed. Before and after treatments, GM characterization was performed by 16S rRNA sequencing while the fecal molecular inflammatory response and the short-chain fatty acids (SCFAs) were respectively determined with the Luminex MAGPIX detection system and a mass chromatography-mass spectrometry method.
RESULTS The Khorasan wheat replacement diet, in comparison with the control wheat diet, had more positive effects on intestinal microbiota composition and on both the fecal immune and SCFAs profiles such as the significant increase of butyric acid levels (P = 0.054), candidatus Saccharibacteria (P = 9.95e-06) and Actinobacteria, and the reduction of Enterococcaceae (P = 4.97e-04). Moreover, the improvement of various FM symptoms along with the variation of some gut bacteria after the Khorasan wheat diet have been documented; in fact we reported positive correlations between Actinobacteria and both Tiredness Symptoms Scale (P < 0.001) and Functional Outcome of Sleep Questionnaire (P < 0.05) scores, between Verrucomicrobiae and both Widespread Pain Index (WPI) + Symptom Severity scale (SS) (P < 0.05) and WPI (P < 0.05) scores, between candidatus Saccharibacteria and SS score (P < 0.05), and between Bacteroidales and Sleep-Related and Safety Behaviour Questionnaire score (P < 0.05).
CONCLUSION The replacement diet based on ancient Khorasan wheat results in beneficial GM compositional and functional modifications that positively correlate with an improvement of FM symptomatology.
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Affiliation(s)
- Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence 50134, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence 50134, Italy
| | - Leandro Di Gloria
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Lavinia Curini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Marco Pallecchi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Sesto Fiorentino 50019, Italy
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Giovanna Danza
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Stefano Benedettelli
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence 50144, Italy
| | - Giovanna Ballerini
- Multidisciplinary Center for Pain Therapy, Reference Center for Fibromyalgia, Piero Palagi Hospital, USL Toscana Centro, Florence 50122, Italy
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Sesto Fiorentino 50019, Italy
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence 50134, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- SOD of Interdisciplinary Internal Medicine, Careggi University Hospital, Florence 50134, Italy
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Green PG, Alvarez P, Levine JD. Probiotics attenuate alcohol-induced muscle mechanical hyperalgesia: Preliminary observations. Mol Pain 2022; 18:17448069221075345. [PMID: 35189754 PMCID: PMC8874179 DOI: 10.1177/17448069221075345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Alcohol use disorder (AUD) is a major health problem that causes millions of deaths annually world-wide. AUD is considered to be a chronic pain disorder, that is exacerbated by alcohol withdrawal, contributing to a high (∼80%) relapse rate. Chronic alcohol consumption has a marked impact on the gut microbiome, recognized to have a significant effect on chronic pain. We tested the hypothesis that modulating gut microbiota through feeding rats with probiotics can attenuate alcohol-induced muscle mechanical hyperalgesia. To test this hypothesis, rats were fed alcohol (6.5%, 4 days on 3 days off) for 3 weeks, which induced skeletal muscle mechanical hyperalgesia. Following alcohol feeding, at which time nociceptive thresholds were ∼37% below pre-alcohol levels, rats received probiotics in their drinking water, either Lactobacillus Rhamnosus GG (Culturelle) or De Simone Formulation (a mixture of 8 bacterial species) for 8 days; control rats received plain water to drink. When muscle mechanical nociceptive threshold was evaluated 1 day after beginning probiotic feeding, nociceptive thresholds were significantly higher than rats not receiving probiotics. Mechanical nociceptive thresholds continued to increase during probiotic feeding, with thresholds approaching pre-alcohol levels 5 days after starting probiotics; nociceptive threshold in rats not receiving probiotics remained low. After probiotics were removed from the drinking water, nociceptive thresholds gradually decreased in these two groups, although they remained higher than the group not treated with probiotic (21 days after ending alcohol feeding). These observations suggest that modification of gut microbiota through probiotic feeding has a marked effect on chronic alcohol-induced muscle mechanical hyperalgesia. Our results suggest that administration of probiotics to individuals with AUD may reduce pain associated with alcohol consumption and withdrawal, and may be a novel therapeutic intervention to reduce the high rate of relapse seen in individuals with AUD attempting to abstain from alcohol.
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Affiliation(s)
- Paul G Green
- Departments of Oral and Maxillofacial Surgery, 8785University of California San Francisco, San Francisco, CA, USA.,Departments of Preventative and Restorative Dental Sciences, 8785University of California San Francisco, San Francisco, CA, USA.,Division of Neuroscience, 8785University of California San Francisco, San Francisco, CA, USA
| | - Pedro Alvarez
- Departments of Oral and Maxillofacial Surgery, 8785University of California San Francisco, San Francisco, CA, USA.,Division of Neuroscience, 8785University of California San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- Departments of Oral and Maxillofacial Surgery, 8785University of California San Francisco, San Francisco, CA, USA.,Division of Neuroscience, 8785University of California San Francisco, San Francisco, CA, USA.,Departments of Medicine, 8785University of California San Francisco, San Francisco, CA, USA
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Stanculescu D, Sepúlveda N, Lim CL, Bergquist J. Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol 2021; 12:789784. [PMID: 34966354 PMCID: PMC8710546 DOI: 10.3389/fneur.2021.789784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 01/01/2023] Open
Abstract
We here provide an overview of the pathophysiological mechanisms during heat stroke and describe similar mechanisms found in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Both conditions are characterized by disturbed homeostasis in which inflammatory pathways play a central role. Splanchnic vasoconstriction, increased gut permeability, gut-related endotoxemia, systemic inflammatory response, central nervous system dysfunction, blood coagulation disorder, endothelial-cell injury, and mitochondrial dysfunction underlie heat stroke. These mechanisms have also been documented in ME/CFS. Moreover, initial transcriptomic studies suggest that similar gene expressions are altered in both heat stroke and ME/CFS. Finally, some predisposing factors for heat stroke, such as pre-existing inflammation or infection, overlap with those for ME/CFS. Notwithstanding important differences - and despite heat stroke being an acute condition - the overlaps between heat stroke and ME/CFS suggest common pathways in the physiological responses to very different forms of stressors, which are manifested in different clinical outcomes. The human studies and animal models of heat stroke provide an explanation for the self-perpetuation of homeostatic imbalance centered around intestinal wall injury, which could also inform the understanding of ME/CFS. Moreover, the studies of novel therapeutics for heat stroke might provide new avenues for the treatment of ME/CFS. Future research should be conducted to investigate the similarities between heat stroke and ME/CFS to help identify the potential treatments for ME/CFS.
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Affiliation(s)
| | - Nuno Sepúlveda
- CEAUL—Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
- Department of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Chin Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jonas Bergquist
- Analytical Chemistry and Neurochemistry, Department of Chemistry—BMC, Uppsala University, Uppsala, Sweden
- The ME/CFS Collaborative Research Center at Uppsala University, Uppsala, Sweden
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Berryman C, Wallwork SB, Heredia-Rizo AM, Knight E, Camfferman D, Russek L, Moseley GL. Are You Listening? Facilitation of the Auditory Blink Response in People with Fibromyalgia. THE JOURNAL OF PAIN 2021; 22:1072-1083. [PMID: 33757876 DOI: 10.1016/j.jpain.2021.03.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 01/21/2023]
Abstract
The purpose of the current study was to determine whether auditory prepulse inhibition (PPI) and/or prepulse facilitation (PPF) were altered in people with fibromyalgia (FM) when compared with controls. Eyeblink responses were recorded from 29 females with FM and 27 controls, while they listened to 3 blocks of auditory stimuli that delivered pulses with either PPI or PPF. Using a linear mixed model, our main findings were that there was a GROUP*CONDITION interaction (F4, 1084 = 4.01, P= .0031) indicating that the difference in amplitude between FM group and control group changed depending on the condition (PPI or PPF). Post hoc tests revealed no differences between the groups in response to PPI. The FM group showed a greater reactivity of response to the PPF conditioned stimulus than the control group did (t(39.7) = 2.03, P= .0494). Augmentation of PPF, as demonstrated by the FM group is thought to be linked to alterations in information processing mediated by an autonomically driven general orienting process. Activities that decrease autonomic drive or rebalance autonomic and parasympathetic tone such as vagal stimulation might be pursued as effective interventions for people with FM. PERSPECTIVE: This article presents evidence of preservation of neural circuitry that underpins response suppression and evidence of neural circuit disturbance mediated by autonomic drive-in people with FM. These results are important because intact circuitry underpins the effectiveness of therapies and may be harnessed, and rebalancing autonomic drive may be indicated.
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Affiliation(s)
- Carolyn Berryman
- Faculty of Health and Medical Science, The University of Adelaide, North Terrace, Adelaide, Australia; IIMPACT in Health, University of South Australia, North Terrace, Adelaide, Australia.
| | - Sarah B Wallwork
- IIMPACT in Health, University of South Australia, North Terrace, Adelaide, Australia
| | - Alberto Marcos Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Emma Knight
- Faculty of Health and Medical Science, The University of Adelaide, North Terrace, Adelaide, Australia
| | | | - Leslie Russek
- Physical Therapy Department, Clarkson University, Potsdam, New York
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, North Terrace, Adelaide, Australia
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Marino C, Grimaldi M, Sabatini P, Amato P, Pallavicino A, Ricciardelli C, D’Ursi AM. Fibromyalgia and Depression in Women: An 1H-NMR Metabolomic Study. Metabolites 2021; 11:429. [PMID: 34209136 PMCID: PMC8304744 DOI: 10.3390/metabo11070429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia is a chronic and systemic syndrome characterized by muscle, bone, and joint pain. It is a gender-specific condition with a 9:1 incidence ratio between women and men. Fibromyalgia is frequently associated with psychic disorders affecting the cognitive and emotional spheres. In the reported work, we compared 31 female fibromyalgia patients to 31 female healthy controls. They were analyzed for biochemical clinical parameters, for autoimmune markers, and were subjected to 1H-NMR metabolomics analysis. To identify a correlation between the metabolomic profile and the psychic condition, a subset of 19 fibromyalgia patients was subjected to HAM-A and HAM-D Hamilton depression tests. Multivariate statistical analysis showed the dysmetabolism of several metabolites involved in energy balance that are associated with systemic inflammatory conditions. The severity of depression worsens dysmetabolic conditions; conversely, glycine and glutamate, known for their critical role as neuromodulators, appear to be potential biomarkers of fibromyalgia and are associated with different severity depression conditions.
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Affiliation(s)
- Carmen Marino
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy; (C.M.); (M.G.); (A.P.); (C.R.)
| | - Manuela Grimaldi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy; (C.M.); (M.G.); (A.P.); (C.R.)
| | - Paola Sabatini
- U.O.C. Clinical Pathology D.E.A. III Umberto I, Viale S. Francesco D’Assisi, 84014 Nocera Inferiore, Italy;
| | - Patrizia Amato
- ASL Ser. T Cava de’ Tirreni, Piazza Matteo Galdi 1/3, 84013 Pregiato, Italy;
| | - Arianna Pallavicino
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy; (C.M.); (M.G.); (A.P.); (C.R.)
| | - Carmen Ricciardelli
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy; (C.M.); (M.G.); (A.P.); (C.R.)
| | - Anna Maria D’Ursi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy; (C.M.); (M.G.); (A.P.); (C.R.)
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Green PG, Alvarez P, Levine JD. A role for gut microbiota in early-life stress-induced widespread muscle pain in the adult rat. Mol Pain 2021; 17:17448069211022952. [PMID: 34096398 PMCID: PMC8186117 DOI: 10.1177/17448069211022952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Adult rats that experienced neonatal limited bedding (NLB), a form of early-life stress, experience persistent muscle mechanical hyperalgesia. Since there is a growing recognition that the gut microbiome regulates pain and nociception, and that early-life stress produces a long-lasting impact on the gut microbiome, we tested the hypothesis that persistent muscle hyperalgesia seen in adult NLB rats could be ameliorated by interventions that modify the gut microbiome. Adult NLB rats received probiotics, either Lactobacillus rhamnosus GG (10 billion CFU/150 ml) or De Simone Formulation (DSF) (112.5 billion CFU/150 ml mixture of 8 bacterial species), in their drinking water, or non-absorbable antibiotics, rifaximin or neomycin, admixed with cookie dough, to provide 50 mg/kg. Mechanical nociceptive threshold in the gastrocnemius muscle was evaluated before and at several time points after administration of probiotics or antibiotics. Adult NLB rats fed probiotics L. Rhamnosus or DSF, antibiotics, as well as rats fed non-absorbable antibiotics rifaximin or neomycin, had markedly attenuated muscle mechanical hyperalgesia. We hypothesize that persistent skeletal muscle hyperalgesia produced by NLB stress may be, at least in part, due to a contribution of the gut microbiome, and that modulation of gut microbiome using probiotics or non-absorbable antibiotics, may be novel therapeutic approaches for the treatment of chronic musculoskeletal pain.
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Affiliation(s)
- Paul G Green
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA,Department of Preventative and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA,Division of Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Pedro Alvarez
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA,Division of Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA,Division of Neuroscience, University of California San Francisco, San Francisco, CA, USA,Department of Medicine, University of California San Francisco, San Francisco, CA, USA,Jon D Levine, University of California San Francisco, Box 0440, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
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The Effect of Multiprobiotics on Memory and Attention in Fibromyalgia: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073543. [PMID: 33805484 PMCID: PMC8038086 DOI: 10.3390/ijerph18073543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic, generalized and diffuse pain disorder accompanied by cognitive deficits such as forgetfulness, concentration difficulties, loss of vocabulary and mental slowness, among others. In recent years, FMS has been associated with altered intestinal microbiota, suggesting that modulating gut microbiota (for example, through probiotics) could be an effective therapeutic treatment. Thus, the aim of the present study was to continue exploring the role of probiotics in cognitive processes in patients with FMS. A pilot randomized controlled trial was conducted in 31 patients diagnosed with FMS to compare the effects of a multispecies probiotic versus a placebo on cognitive variables (memory and attention) after eight weeks. Results showed that treatment with a multispecies probiotic produced an improvement in attention by reducing errors on an attention task, but it had no effect on memory. More specifically, a tendency to reduce errors of omission (Go trials) during the Go/No-Go Task was observed after treatment. These findings, along with our previous results in impulsivity, underline the relevance of using probiotics as a therapeutic option in FMS, although more research with a larger sample size is required.
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Livshits G, Kalinkovich A. Specialized, pro-resolving mediators as potential therapeutic agents for alleviating fibromyalgia symptomatology. PAIN MEDICINE 2021; 23:977-990. [PMID: 33565588 DOI: 10.1093/pm/pnab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To present a hypothesis on a novel strategy in the treatment of fibromyalgia (FM). DESIGN A narrative review. SETTING FM as a disease remains a challenging concept for numerous reasons, including undefined etiopathogenesis, unclear triggers and unsuccessful treatment modalities. We hypothesize that the inflammatome, the entire set of molecules involved in inflammation, acting as a common pathophysiological instrument of gut dysbiosis, sarcopenia, and neuroinflammation, is one of the major mechanisms underlying FM pathogenesis. In this setup, dysbiosis is proposed as the primary trigger of the inflammatome, sarcopenia as the peripheral nociceptive source, and neuroinflammation as the central mechanism of pain sensitization, transmission and symptomatology of FM. Whereas neuroinflammation is highly-considered as a critical deleterious element in FM pathogenesis, the presumed pathogenic roles of sarcopenia and systemic inflammation remain controversial. Nevertheless, sarcopenia-associated processes and dysbiosis have been recently detected in FM individuals. The prevalence of pro-inflammatory factors in the cerebrospinal fluid and blood has been repeatedly observed in FM individuals, supporting an idea on the role of inflammatome in FM pathogenesis. As such, failed inflammation resolution might be one of the underlying pathogenic mechanisms. In accordance, the application of specialized, inflammation pro-resolving mediators (SPMs) seems most suitable for this goal. CONCLUSIONS The capability of various SPMs to prevent and attenuate pain has been repeatedly demonstrated in laboratory animal experiments. Since SPMs suppress inflammation in a manner that does not compromise host defense, they could be attractive and safe candidates for the alleviation of FM symptomatology, probably in combination with anti-dysbiotic medicine.
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Affiliation(s)
- Gregory Livshits
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alexander Kalinkovich
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Toner A, Lewis JS, Stanhope J, Maric F. Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1876598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Adam Toner
- Physiotherapy Department, Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
- Rehabilitation Services, UW Health, Madison, WI, USA
| | - Jeremy S. Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
| | - Jessica Stanhope
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Filip Maric
- Institute of Health and Care Sciences, Unviersity of Tromsø, Norway
- Environmental Physiotherapy Association (EPA), Tromsø, Norway
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de Carvalho JF, Lerner A. Fibromyalgia associated with Chagas' disease treated with nutraceuticals. Clin Nutr ESPEN 2021; 42:212-214. [PMID: 33745580 DOI: 10.1016/j.clnesp.2021.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe a patient with Chagas' disease diagnosed with concomitant fibromyalgia and treated by an alternative approach and review the fibromyalgia-infections relationship. METHODS The literature was reviewed for fibromyalgia association with infectious agents, using PubMed, spanning 2000-2020. The keywords were: fibromyalgia, infections, bacteria, microbe, and parasite. A case report is described. CASE REPORT A 61-year-old female patient with a past medical history of Chagas' disease, presented with megaesophagus and dolichomegacolon for 30 years. Untreated anxiety accompanied her gastrointestinal manifestations. For the last ten years, she felt diffuse pain on both sides of the body, and in the upper and lower parts associated with sleep difficulties. On examination, she had 18 tender points, thus fulfilled the diagnostic criteria of fibromyalgia. 25-OH vitamin D was 26 ng/mL (>30 ng/mL). Serology for Chagas' disease was positive by two techniques (ELISA and indirect immunofluorescence), and the routine laboratory was within normal ranges. Psychotherapy, vitamin D 50,000 IU/week, and physical exercise (Pilates exercise twice a week and distance walking 3 times per week) were initiated. No antidepressant was prescribed due to the risk of detrimental gastrointestinal motility effects. After six months, the patient experienced a marked improvement in her clinical condition, the pain was almost absent, and anxiety was under control, and vitamin D levels were normal. Her quality of life improved substantially. Reviewing the literature on associated infections in myalgia/fibromyalgia disclosed multiple viral, bacterial, and parasitic agents. None mentioned Trypanosoma cruzi. CONCLUSION The present case illustrates the first patient with Chagas-related dolichomegacolon who evolved with fibromyalgia and was successfully treated by psychotherapy, Pilates exercise, and vitamin D. It appears that myalgia and/or fibromyalgia are associated with numerous infectious agents, including parasites, but the association of fibromyalgia and T. cruzi, was not found.
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Affiliation(s)
| | - Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Center, for Autoimmune Diseases Tel-Hashomer, Israel
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Bannerman CA, Douchant K, Sheth PM, Ghasemlou N. The gut-brain axis and beyond: Microbiome control of spinal cord injury pain in humans and rodents. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2021; 9:100059. [PMID: 33426367 PMCID: PMC7779861 DOI: 10.1016/j.ynpai.2020.100059] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is a devastating injury to the central nervous system in which 60 to 80% of patients experience chronic pain. Unfortunately, this pain is notoriously difficult to treat, with few effective options currently available. Patients are also commonly faced with various compounding injuries and medical challenges, often requiring frequent hospitalization and antibiotic treatment. Change in the gut microbiome from the "normal" state to one of imbalance, referred to as gut dysbiosis, has been found in both patients and rodent models following SCI. Similarities exist in the bacterial changes observed after SCI and other diseases with chronic pain as an outcome. These changes cause a shift in the regulation of inflammation, causing immune cell activation and secretion of inflammatory mediators that likely contribute to the generation/maintenance of SCI pain. Therefore, correcting gut dysbiosis may be used as a tool towards providing patients with effective pain management and improved quality of life.
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Affiliation(s)
- Courtney A. Bannerman
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Katya Douchant
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Prameet M. Sheth
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
- Division of Microbiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Nader Ghasemlou
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
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Erdrich S, Hawrelak JA, Myers SP, Harnett JE. A systematic review of the association between fibromyalgia and functional gastrointestinal disorders. Therap Adv Gastroenterol 2020; 13:1756284820977402. [PMID: 33343707 PMCID: PMC7727037 DOI: 10.1177/1756284820977402] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Fibromyalgia and functional gastrointestinal disorders (FGID) including irritable bowel syndrome (IBS) are common conditions presenting in clinical settings and are more prevalent in women. While the relationship between IBS and fibromyalgia has been demonstrated, a review of the prevalence of the broader group of FGID in adults with fibromyalgia has not been undertaken. The aim of this review was to systematically review the published literature, identifying the comorbidity of FGID in people with fibromyalgia, and to discuss the clinical implications, limitations of current research and areas of interest for future research. METHODS Medline, Embase, CINAHL and Web of Science were searched during June 2019. Results were screened for original research articles meeting established criteria for identification of FGID in adults diagnosed with fibromyalgia. RESULTS A total of 14 studies involving 1340 adults with fibromyalgia, 363 healthy controls and 441 adults with other pathologies were included in this review. Only 1 of the 14 studies included surveyed the full range of FGID . Functional gut disorders were matched to Rome II criteria for reporting and comparison. In addition to increased abdominal pain and functional bloating or gas, IBS of mixed-pattern and constipation-types appear to be more prevalent than diarrhoea-predominant IBS in adults with fibromyalgia. CONCLUSION This review confirms previous reports that IBS is common in people living with fibromyalgia and suggests that IBS-mixed and constipation types predominate. An association with a range of FGID other than IBS is suggested, but data are limited. Research exploring the association between fibromyalgia and functional gastrointestinal dysfunction beyond IBS are warranted.
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Affiliation(s)
- Sharon Erdrich
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Science Road, Camperdown, Sydney, New South Wales 2006, Australia
| | - Jason A. Hawrelak
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen P. Myers
- NatMed Research Unit, Office of the Deputy Vice Chancellor (Research), Southern Cross University, Lismore, New South Wales, Australia
| | - Joanna E. Harnett
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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