Gut health is a topic drawing increased interest in the medical community over the last few decades. The gut is no longer considered a tube through which food passes in the body. The gut is considered an ‘organ’ due to its complexity and significance to overall health.

The complex gut microbiome remains a less understood area of human health. Gut microbiome refers to the microorganisms living in human intestines. Are you aware that there are approximately 500 different bacteria species in your gut? The majority of these bacteria species are beneficial and have a significant role in overall health. Specific foods and dietary patterns can all influence the abundance of different types of bacteria in the gut, which in turn can affect health.

Increasing sets of evidence support the role of gut microbiome in human health. Different studies have shown the links between gut health and multiple health conditions such as compromised immunity, autoimmune diseases, chronic pain, mental health, mood, cancer, obesity, and skin conditions.

At Integrative Physio, we elaborate to our patients on how microbial imbalances in the gut (dysbiosis) may lead to dysfunction and progression toward a broad spectrum of diseases.

Gut Health and Chronic Pain

Gut health is affected by high stress levels, inadequate sleep, processed and high-sugar foods, and antibiotics. Inflammatory bowel disease (IBD), a chronic inflammatory condition that affects your gut, is closely associated with musculoskeletal pain. People who have IBD report experiencing persistent pain besides the typical intestinal problems.

A recently published study has investigated the predictive relationship between active IBD and presence of musculoskeletal (MSK) conditions. A subgrouping analysis identified three relevant clinical subgroups to describe pain presentation in IBD patients. IBD is linked to the severity of musculoskeletal pain with up to 70% of patients reporting abdominal and musculoskeletal pain.

How Gut Health Leads to Persistent Pain

What do we know? There are no direct measures of central sensitization in human beings. Central sensitization refers to the increased responsiveness of neurons within the central nervous system that leads to pain hypersensitivity. Inflammatory conditions are known to trigger changes in both the central and peripheral nervous systems leading to chronic pain. A central sensitization inventory (CSI) score is the tool used to identify symptoms that define central sensitivity syndromes.

For active IBD patients, recurrent incidences of intestinal inflammation lead to heightened sensitization of the central nervous system. Effectively, we can identify a correlation between active IBD, symptoms of central sensitization, and musculoskeletal pain experiences.

The CSI scores for the study participants ranged from 12 to 82 with 75% of participants reporting a score greater than 40. A higher score indicates severity of MSK pain. In addition, study participants reported that they experienced the greatest pain in the lower back. IBD activity is a significant predictor of increased CSI scores and severity of musculoskeletal pain. In addition, CSI score was a significant predictor of increased severity of musculoskeletal pain. CSI mediates the relationship between IBD activity and MSK pain experiences.

The study findings reveal a significant positive predictive relationship between active IBD and worsening MSK pain severity and interference. CSI was a significant variable in the link between IBD and chronic pain, giving an explanation of central sensitization symptoms. We use CSI, a self-report assessment, to help in the identification of patients that have IBD-related conditions or comorbidities associated with central sensitization. By working closely with IBD patients, our nutritionist will create custom nutrition plans that eliminate specific food types that cause chronic inflammatory responses and prevents nutritional deficiencies that are associated with the IBD-related conditions. Our nutrition plans will contain diets that may induce or maintain remission and diets that alleviate symptoms of IBD including pain. We recognize dietary intervention/recommendation as a primary therapy for IBD to control inflammatory activity, prevent worsening of pain, and even eliminate or delay the need for surgery.

Conclusion

CSI score helps our physiotherapists to factor central sensitization in diagnostic testing. Patients with IBD are 2 to 3 times more likely to develop chronic pain following gastrointestinal surgery than non-IBD populations. The screening tool can help patients that need IBD-related postsurgical and abdominal pain immensely. Central sensitization plays a major role in the pathophysiology of chronic postsurgical pain. It is worsened by prior disease inflammation and explains the increased prevalence of chronic pain in IBD patients.

Using the findings of the study, the team at Integrative Physio will devise targeted chronic pain management frameworks for patients presenting symptoms of central sensitization. The pain management frameworks would also factor in age and nutrition as factors influencing musculoskeletal pain interference. Contact us to learn more about your gut health and how it could be worsening chronic pain.

How Gut Health Can Influence Pain?