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Rambam HCC and McGill University: Fibromyalgia Pain is in the Gut

Publication Date: 7/21/2022

A new study conducted by Rambam HCC and McGill University scientists has found changes in women’s blood bile acids that are associated to the gut microbiome. Their research could provide a new molecular methodology for diagnosing fibromyalgia.

Dr.  Amir Minerbi, Deputy Director of the Rambam Institute for Pain Medicine. Photography:  Rambam HCCDr. Amir Minerbi, Deputy Director of the Rambam Institute for Pain Medicine. Photography: Rambam HCC

Affecting around four per cent of the population and mostly women, fibromyalgia is a syndrome that causes symptoms like pain, fatigue and cognitive issues. Poorly understood, the condition has no cure and is difficult to diagnose. However, scientists at the Institute for Pain Medicine at Rambam Health Care Campus (Rambam HCC) and the Research Institute of McGill University Health Centre (RI-MUHC) have been researching the condition and made some important new discoveries.

Already in 2019, the research team had found indications that the gut microbiome – a community of microorganisms found in the digestive tract – played a role in chronic pain, including that experienced in fibromyalgia. Now, the same research team, including Amir Minerbi from Rambam’s Institute of Pain Medicine, Nicholas Bereton from University of Montreal, and McGill University researchers Emmanuel Gonzalez, Mary-Ann Fitzcharles, Stéphanie Chevalier, and Yoram Shir have a new publication that adds to their research and may ultimately lead to a clear diagnosis of fibromyalgia. Titled, “Altered Serum Bile-Acid Profile in Fibromyalgia is Associated with Specific Gut Microbiome Changes and Symptom Severity,” their research presents the first evidence that women with fibromyalgia have different amounts and species of bile-metabolizing gut bacteria and different bile acid concentrations in the blood, compared to healthy people. They also found that some of these differences correlated with symptom severity. Published in the scientific journal PAIN, these findings could pave the way for new diagnostic and therapeutic tools for those suffering from fibromyalgia.

“The change in bile acids that we observed in patients with fibromyalgia in our study is distinct enough to be used as an effective biological signature to detect individuals with fibromyalgia. That’s an important step forward, considering that diagnosing fibromyalgia is often a long process that requires eliminating other conditions that can cause similar symptoms,” says Dr. Minerbi, a joint first author of the study who recently returned to Rambam’s Institute for Pain Medicine after an extended time in the Alan Edwards Pain Management Unit at McGill University Health Centre.

Using artificial intelligence, the team also found that the presence of six specific secondary bile acids was more than 90 percent accurate in predicting if a study participant had fibromyalgia.

“Machine and statistical learning have helped us to characterize which gut bacteria change in abundance and which human bile acids are important makers of the disease,” says study joint-first author Dr. Emmanuel Gonzalez, from the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “These approaches provided an accurate biological signature of fibromyalgia. Although our study cohort was relatively small, these findings are a promising sign that artificial intelligence might be able to considerably enhance accurate diagnosis of the disease.”

Fibromyalgia is a condition that is surrounded by facts and myths. It was only recognized as a disabling condition by Israel’s National Insurance Institute in 2021. Hence, the findings of this research are clearly good news for fibromyalgia patients.

Dr. Yoram Shir, from the Edwards Pain Management Unit of MUCH concludes, “Our findings show a strong relationship between patient microbiome composition, bile acids and the severity of fibromyalgia symptoms. Understanding the biological mechanism of fibromyalgia is critical, because it shows that this condition is real, and because it brings us closer to developing an effective treatment to these women and men in pain.”

For More Information

Read the original McGill University Press Release

Read the 2022 article by Minerbi et al. published in PAIN

Read the 2019 article by Minerbi et al. published in PAIN