November 18, 2021 – Fibromyalgia—an illness characterized by chronic pain throughout the body, fatigue, and sleep disturbance—is very common, affecting two to eight percent of the population. Researchers in the Pain Medicine Institute at Rambam Health Care Campus led by Director Dr. Simon Vulfsons are working hard to find a cure, and may have found a solution in the most unlikely of places.

Researchers have discovered that microbiome—microorganisms found in the body—is connected to a multitude of illnesses and conditions, and that the microbiome in people suffering from these conditions is different from the microbiome of healthy people. In these situations, not only are the different microbiome present – they actually play an active role.

In light of these discoveries, Rambam’s pain doctors and researchers began to wonder if microbiome might also have an impact on chronic pain, and Dr. Amir Minerbi, the Pain Medicine Institute’s Deputy Director, set the wheels in motion during his fellowship at Montreal’s McGill University, in collaboration with Dr. Yoram Shir, Director of the university’s Alan Edwards Pain Management Unit and Dr. Arkady Khoutorsky, whose laboratory plays an instrumental role in the research.

Minerbi and his colleagues recruited two groups of women – one group with verified fibromyalgia diagnoses and one group of healthy women, in order to study the microbiome of the participants in both groups, examining every possible element that could impact the composition, including what they ate, whether they were physically active, and others. “What we saw was that at the macro level, the microbiome was quite similar between the two groups. However, when we examined it at a deeper level, we discovered several species of microbiome that were different in the fibromyalgia sufferers,” explains Minerbi.

The initial results were significant, offering conclusive proof that fibromyalgia is an actual physical illness as well as demonstrating a connection between the composition of the microbiome and the illness, though there was no indication as to whether the microbiome had caused the fibromyalgia or the fibromyalgia had altered the microbiome.

In the second phase, the researchers implanted microbiome samples from three women suffering from fibromyalgia and three healthy women in a large group of germ-free mice, in order to assess whether the microbiome actually caused the illness.

Within two weeks of microbiome implantation from the fibromyalgia sufferers, the mice began to suffer from pain. They also became less active, and started to experience sleep disturbances. The other mice remained healthy. “We managed to demonstrate that not only was the microbiome different – it also caused the pain,” notes Minerbi.

The most fascinating aspect of the phase was that they managed to completely reverse the process in all three mice, by implanting microbiome from healthy people.

Following the success of the first two phases, Minerbi and his colleagues will attempt to replicate these same processes in humans. In the next few months, they will begin clinical trials to start treating fibromyalgia sufferers using microbiome implants – something that has never been done anywhere in the world.

“We are quite optimistic. As a result of the research on mice, we have an understanding of the mechanisms that cause fibromyalgia, and we are hopeful that we might be able to treat humans in the same way. If we succeed, it will be huge.”

In the photo: Dr. Amir Minerbi, Deputy Director of Rambam’s Pain Medicine Institute.

Photography courtesy of Rambam Health Care Campus.