Fibromyalgia And Irritable Bowel Syndrome Interaction: A Possible Role For Gut Microbiota And Gut-Brain AxisⅠ
Dec 06, 2023
Abstract:
Fibromyalgia (FM) is a serious chronic pain syndrome, characterized by muscle and joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and intestinal irritability. Irritable Bowel Syndrome (IBS) shares many of these symptoms, and FM and IBS frequently co-exist, which suggests a common etiology for the two diseases. The exact physiopathological mechanisms underlying both FM and IBS onset are unknown. Researchers have investigated many possible causes, including alterations in gut microbiota, which contain billions of microorganisms in the human digestive tract. The gut-brain axis has been proven to be the link between the gut microbiota and the central nervous system, which can then control the gut microbiota composition. In this review, we will discuss the similarities between FM and IBS. Particularly, we will focus our attention on the symptomatology overlap between FM and IBS as well as the similarities in microbiota composition between FM and IBS patients. We will also briefly discuss the potential therapeutic approaches based on microbiota manipulations that are successfully used in IBS and could be employed in FM patients to relieve pain and ameliorate the rehabilitation outcome, psychological distress, and intestinal symptoms.
1. Introduction
Fibromyalgia syndrome (FM) is the most disabling chronic pain syndrome [1,2], characterized by abnormal and intense enhancement of pain perception with hyperalgesia, allodynia, and receptive field expansion [3,4], usually associated with muscle and joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, and intestinal irritability [5,6]. All these symptoms cause a significant impairment in the FM patients' quality of life, with the inability to perform normal daily activities [5]. The American College of Rheumatology (ACR) has established criteria for FM diagnosis mostly based on two variables: (i) bilateral pain above and below the waist with centralized pain; and (ii) chronic generalized pain for at least three months. According to these criteria, pain is observed on palpation in at least 11 of 18 specific body sites [2,5]. FM especially affects women, with an estimated prevalence ranging from 0.2% to 6.6% [5] and with an age range onset between 30 and 35 years [2].
FM is currently classified under the group of central sensitivity disorders [3,7], which also include chronic fatigue syndrome, irritable bowel syndrome (IBS), temporomandibular joint dysfunction, and tension headache. Notably, a high rate of comorbidity has been reported between FM and the other central sensitivity syndromes [8–10]. The International Association for the Study of Pain (IASP) has proposed a new classification for chronic pain [1], distinguishing between primary and secondary pain syndromes. FM has been included in musculoskeletal primary pain disorders, together with complex regional pain syndrome and nonspecific low back pain [1,11].
Stress and depression are considered potent factors involved in the physiopathology of FM for their capability to dysregulate neuroendocrine, immune, and pain mechanisms, resulting in various dysfunctions, such as motor impairment, cognition impairment, depression, and long-term pain [12–14]. The lifetime prevalence of depressive disorders in FM patients ranges between 40 and 80%, depending on the employed diagnostic criteria [12,14]. Moreover, FM may occur with other chronic inflammatory diseases such as rheumatoid arthritis, osteoarthritis, and systemic lupus erythematosus [13,15]. Although the etiology of FM is not completely understood, the involvement of several biological factors has been suggested, including abnormalities of the hypothalamic–pituitary–adrenal axis (HPA), dysfunction of the autonomic nervous system, genetic factors, immunological alterations, oxidative stress, psychosocial variables, and environmental stressors [4,5,13,16].
IBS is one of the most prevalent chronic gastrointestinal diseases [17], mainly characterized by recurrent abdominal pain associated with alterations in either stool form or frequency, bloating, gas, diarrhea, or constipation [18]. Diagnosis is based on the current symptom-based criteria for IBS (Rome IV criteria), which must occur for at least 6 months [19]. This condition affects 4–10% of the global population and is associated with markedly reduced quality of life [20,21]. IBS is most common among women aged 20–40 years [22,23]. As for FM, IBS pathophysiology is still unclear and several factors have been implicated, such as genetic and environmental factors, mucosal immune dysfunction, intestinal dysmotility, increased intestinal permeability, and visceral hypersensitivity [17,18]. Psychological stress and diet are also considered two important environmental factors closely linked to IBS. Previous acute enteric infections, observed in approximately 10% of IBS patients, represent another important factor contributing to predisposing subjects to this syndrome [17,24].
All these factors might influence symptom severity. Of notice, IBS is also associated with common extra intestinal comorbidities including anxiety, depression, somatization, insomnia, chronic fatigue, and psychological disorders [25]. The coexistence between IBS and FM has been widely observed. Both FM and IBS are more prevalent in women [26] and are characterized by sympathetic dysfunction with central sensitization [27,28]. A link between FM and IBS was first postulated by Yunus et al. in 1981, who demonstrated that the prevalence of IBS in FM patients was approximately 50–70% [29]. Several further studies confirmed the high prevalence of IBS in FM and vice versa [30–36]. Accordingly, symptoms and signs of anxiety occur significantly more frequently in IBS patients than in controls and a sleep disturbance, typically associated with FM, has been described in up to 30% of IBS patients [30]. On the other hand, gastrointestinal symptoms in FM patients were reported to worsen during stress or disease exacerbations [37].
The coexistence of IBS and anxiety and depression has been observed in 30–35% of FM patients [34]. All these data support the notion that FM is not only a musculoskeletal disorder but also shows signs of psychological as well as intestinal distress. However, the specific cause underlying this heterogeneity in symptomatology is not well defined. Alterations in gut microbiota and the gut-brain axis, which connect the gut microbiota with the brain through the enteric nervous system, have been proposed as a possible FM pathogenetic mechanism [13,38]. In this review, we will discuss the alterations of microbiota and the gut-brain axis in FM and IBS patients, highlighting the similarities between these two syndromes and providing possible mechanisms involved in the physiopathology of FM. Based on therapeutic regimens used in IBS, we will also propose a possible therapeutic strategy to improve FM patients' quality of life.
Natural Herbal Medicine For Relieving Constipation-Cistanche
Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to aging, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.
Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. Promoting hydration and lubrication of the Intestines may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. Reducing inflammation in the intestines may help improve bowel movement regularity and relieve constipation.
