author/presenter Crimean State Medical University named after S.I.Georgivesky Nawan Shaher, Punjab
Background: Emerging evidence suggests that gut-brain axis dysfunction plays a central role in the pathogenesis of central sensitization syndromes (CSS) such as fibromyalgia, irritable bowel syndrome (IBS), and chronic fatigue syndrome. Shared mechanisms include altered microbiota, intestinal permeability, and neuroinflammation. This study explores the clinical utility of a gut-focused evaluation in a cross-specialty pain-gastroenterology clinic.
Purpose/Objectives: The purpose of this study was to evaluate the clinical value of integrating gut-brain axis assessment into the management of patients with central sensitization syndromes, such as fibromyalgia and irritable bowel syndrome. The objective was to determine whether targeted gastrointestinal interventions—based on findings like SIBO, dysbiosis, or food sensitivities—could improve both chronic pain and GI symptoms, and to assess the effectiveness of a collaborative care model between pain management and gastroenterology in a real-world clinical setting.
Methods: A retrospective review was performed on 45 patients referred to a joint pain-gastroenterology clinic between January 2023 and February 2024. All had diagnoses of fibromyalgia or other CSS and had symptoms suggestive of gastrointestinal dysregulation (bloating, constipation, diarrhea, or nausea). Evaluations included pain history, GI symptom inventory, and testing for small intestinal bacterial overgrowth (SIBO), food sensitivity, and microbiome diversity. Treatment plans were multidisciplinary, involving low FODMAP diets, probiotics, neuromodulators, and visceral physical therapy.
Results: Among 45 patients, 36 (80%) had positive findings on SIBO breath testing or dysbiosis panels. Intervention led to significant improvements in both GI and pain symptoms in 28 patients (62%), with average pain scores decreasing from 6.9 to 4.2 on a numeric rating scale after 3 months. Patients who responded to GI-directed therapy also reported improved energy levels and cognitive clarity. Qualitative reports indicated patients appreciated the integrative approach and felt their symptoms were more “believable” when addressed jointly.
Conclusions/Implications for future research and/or clinical care: Gut-brain axis evaluation offers meaningful clinical insight and treatment benefit in patients with central sensitization syndromes. Collaborative care between pain and GI specialists may improve outcomes in patients often labeled “difficult to treat.” Further prospective studies are needed to establish standardized protocols.
