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In recent years, it has been hypothesized that the increasing incidence of autoimmune diseases may be due, in part, to shifts in the gut microbiota.¹ Dysbiosis in the gut microbiome may trigger gut barrier dysfunction such as changes in tight junctions, mucous layers, and secretion of immunoglobulin A and intraepithelial lymphocytes.¹

Further, research suggests that gut dysbiosis may influence a systemic immune response and impact pain thresholds in some autoimmune conditions like Guillain-Barré syndrome,³ systemic lupus erythematous (SLE),^2,4 multiple sclerosis (MS), and rheumatoid arthritis (RA).^2,4-5 Gut microflora can be modulated by extrinsic factors, including dietary habits, lifestyle, infection, and early microbial exposure, as well as intrinsic factors such as metabolites, immunity, and hormones.² Specific to pain thresholds, is it possible to manage the pain of autoimmune diseases by changing the composition of the gut microbiota?

Research is still in its infancy and studies show conflicting results. However, a 2021 systematic review and meta-analysis of 19 studies suggests that in adults older than 18 years (92% female), anti-inflammatory diets (Mediterranean, vegetarian, and vegan) may result in significantly lower pain than a highly omnivorous diets (-9.22 mm; 95% CI -14.15 to -4.29; p=0.0002).⁶ Subgroup analysis showed that Mediterranean diets tended to have a greater effect on pain than vegetarian or vegan diets did (-14.99 mm, 95% CI -22.87 to -7.11 mm; p=0.0002). Studies with intervention periods lasting longer than three months also showed greater effects.⁶

Pain Medications & Gut Support

One of the common treatments for chronic pain frequently experienced by autoimmune patients⁷ is nonsteroidal anti-inflammatory drugs (NSAIDs), which are known to increase intestinal permeability and may lead to endotoxemia, enteropathy, and further complications.⁸

Reducing these potential side effects from pain medications in autoimmune patients is possible. IFM educator Helen Messier, PhD, MD, shares ways to support gut health while also addressing pain related to autoimmunity.

Researchers continue to explore the microbiome as a means of discovering safe and non-pharmacologic methods for managing the painful symptoms of autoimmune disorders. The gut-brain axis plays an integral role in human health and disease,² and a deeper understanding of the bidirectional communication and homeostatic interplay between the gut microbiota and the central nervous system may aid the discovery of new therapeutic targets for autoimmune patients.

Functional Medicine Considerations

Functional medicine recognizes the triad of genetics, environmental triggers, and intestinal permeability as being at the forefront of autoimmune disease research, and in many ways, the functional medicine model is specifically designed to address these factors. With its focus on understanding each individual’s unique genetics and environment—and the interactions between them—as well as its longstanding appreciation of the importance of the microbiome and intestinal permeability, functional medicine provides the perfect opportunity to address dysbiosis and favorably impact the onset and progression of immune-related diseases.

Related Articles

Stress, Trauma, and Dysbiosis: Connecting the Gut-Brain Axis to Autoimmune Disease

Understanding the Psychoemotional Roots of Immune Disease

Antinuclear Antibodies and Autoimmune Disease

References

1. Xu Huihui, Liu M, Cao J, et al. The dynamic interplay between gut microbiota and autoimmune diseases. J Immunol Res. 2019;2019:7546047. doi:1155/2019/7546047
2. Zhu S, Jiang Y, Xu K, et al. The progress of gut microbiome research related to brain disorders. J Neuroinflammation. 2020;17(1):25. doi:1186/s12974-020-1705-z
3. Mousa WK, Chehadeh F, Husband S. Microbial dysbiosis in the gut drives systemic autoimmune diseases. Front Immunol. 2022;13:906258. doi:3389/fimmu.2022.906258
4. Wang Y, Wei J, Zhang W, et al. Gut dysbiosis in rheumatic diseases: a systematic review and meta-analysis of 92 observational studies. EBioMedicine. 2022;80:104055. doi:1016/j.ebiom.2022.104055
5. Alwarith J, Kahleova H, Rembert E, et al. Nutrition interventions in rheumatoid arthritis: the potential use of plant-based diets. A review. Front Nutr. 2019;10(6):141. doi:3389/fnut.2019.00141
6. Schönenberger KA, Schüpfer AC, Gloy VL, Hasler P, et al. Effect of anti-inflammatory diets on pain in rheumatoid arthritis: a systematic review and meta-analysis. Nutrients. 2021;13(12):4221. doi:3390/nu13124221
7. Mifflin KA, Kerr BJ. Pain in autoimmune disorders. J Neurosci Res. 2017;95(6):1282-1294. doi:1002/jnr.23844
8. Utzeri E, Usai P. Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(22):3954-3963. doi:3748/wjg.v23.i22.3954