Fecal Microbiota Transplantation Improves Clinical Symptoms of Fibromyalgia: An open-label, Randomized, Nonplacebo-Controlled Study

Hongwei Fang; Qianhao Hou; Wei Zhang; Zehua Su; Jinyuan Zhang; Jingze Li; Jiaqi Lin; Zetian Wang; Xiuqin Yu; Yu Yang; Qing Wang; Xin Li; Yuling Li; Lungui Hu; Shun Li; Xiangrui Wang; Lijun Liao

doi:10.1016/j.jpain.2024.104535

Fecal Microbiota Transplantation Improves Clinical Symptoms of Fibromyalgia: An open-label, Randomized, Nonplacebo-Controlled Study

J Pain. 2024 Apr 23:104535. doi: 10.1016/j.jpain.2024.104535. Online ahead of print.

Authors

Hongwei Fang¹, Qianhao Hou², Wei Zhang², Zehua Su², Jinyuan Zhang², Jingze Li³, Jiaqi Lin⁴, Zetian Wang⁴, Xiuqin Yu⁴, Yu Yang⁵, Qing Wang⁴, Xin Li⁴, Yuling Li⁴, Lungui Hu⁴, Shun Li⁶, Xiangrui Wang², Lijun Liao⁷

Affiliations

¹ Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Pain Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Pain Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
⁴ Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
⁵ Department of Anesthesiology, Huangpu Branch of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
⁶ Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
⁷ Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Pain Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China. Electronic address: liao@pan-intelligence.com.

PMID: 38663650
DOI: 10.1016/j.jpain.2024.104535

Abstract

Fibromyalgia (FM) is a complex and poorly understood disorder characterized by chronic and widespread musculoskeletal pain, of which the etiology remains unknown. Now, the disorder of the gut microbiome is considered as one of the main causes of FM. This study was aimed to investigate the potential benefits of fecal microbiota transplantation (FMT) in patients with FM. A total of 45 patients completed this open-label randomized, nonplacebo-controlled clinical study. The Numerical Rating Scale (NRS) scores in the FMT group were slightly lower than the control group at 1 month (P> 0.05), and they decreased significantly at 2, 3, 6, and 12 months after treatment (P < 0.001). Besides, compared with the control group, the Widespread Pain Index (WPI), Symptom Severity (SS), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) scores were significantly lower in the FMT group at different time points (P < 0.001). After 6 months of treatment, there was a significant increase in serotonin (5-HT) and gamma-aminobutyric acid (GABA) levels (P < 0.001), while glutamate levels significantly decreased in the FMT group (P < 0.001). The total effective rate was higher in the FMT group (90.9%) compared to the control group (56.5%) after 6 months of treatment (P < 0.05). FMT can effectively improve the clinical symptoms of FM. With the close relations between the changes of neurotransmitters and FM, certain neurotransmitters may serve as a diagnostic marker or potential target for FM patients. PERSPECTIVE: Fecal microbiota transplantation (FMT) is a novel therapy that aims to restore the gut microbial balance and modulate the gut-brain axis. It is valuable to further explore the therapeutic effect of FMT on FM. Furthermore, certain neurotransmitters may become a diagnostic marker or a new therapeutic target for FM patients.

Keywords: 5-hydroxytryptamine; Chronic pain; Fecal Microbiota Transplantation; Fibromyalgia; Neurotransmitters.