DR MICHAEL MOSLEY: New ways to conquer chronic pain from gut microbe transplants to medical cannabis


The worst pain I have ever experienced was an infected tooth, which suddenly and unexpectedly developed one Saturday night.

It was too late to ring my dentist, so I went rampaging through our cupboards looking for painkillers. Sadly all we had was paracetamol and ibuprofen, which I alternated taking, while rubbing my gums with oil of cloves (which helped a bit).

First thing Monday morning I managed to get an emergency appointment. It is hard to describe the joy I felt of being in the hands of the dentist, having the numbing injection and the reassuring sound of the drill. And the relief afterwards.

So I can’t imagine how difficult it must be for people living in long-term pain — yet according to a recent report, by their mid-40s more than 40 per cent of Britons struggle with chronic pain (defined as pain that lasts longer than three months), typically back pain, arthritis or fibromyalgia.

The report, based on the National Child Development Survey (which has been monitoring 12,000 people born in 1958), showed that being in chronic pain also led to depression, poor general health and joblessness.

By their mid-40s more than 40 per cent of Britons struggle with chronic pain (defined as pain that lasts longer than three months)

Unlike acute pain, where the cause is obvious and generally short-lived (you stub your toe, for instance), chronic pain is altogether more mysterious. It can be triggered by an obvious injury or infection, but in many cases there is not clear cause.

However, the latest research suggests some potentially exciting new approaches to treating chronic pain.

Gut Microbes Transplant 

Surprisingly, a recent study has found that the gut microbiota, the trillion or so microbes that live in our guts and which shape our health in ways we’re only just beginning to understand, may play a part in chronic pain.

Researchers at McGill University in Canada discovered this after comparing the gut microbiota of 178 people, 77 of whom had fibromyalgia (which causes widespread pain, often accompanied by muscle stiffness, extreme tiredness, headaches and bloating). Fibromyalgia can take many years to diagnose and is difficult to treat.

Gut microbiota, the trillion or so microbes that live in our guts and which shape our health in ways we¿re only just beginning to understand, may play a part in chronic pain

Gut microbiota, the trillion or so microbes that live in our guts and which shape our health in ways we’re only just beginning to understand, may play a part in chronic pain

“We may be done with Covid, but it isn’t done with us.” 

Recent evidence suggests the new booster shots generate a superior immune response

Recent evidence suggests the new booster shots generate a superior immune response

Despite the threat of a winter ‘twindemic’ of flu and coronavirus, fewer than half of people eligible for a Covid jab have had one so far.

I’ve had both — and though my arms were sore for a few hours, I had no other side-effects. It’s worthwhile, particularly as recent evidence suggests the new booster shots generate a superior immune response, with much higher levels of antibodies, which in turn provide greater protection against hospitalisation or long Covid.

We may be done with Covid, but it isn’t done with us.

By comparing poo samples taken from people with and without fibromyalgia, researchers were able to identify a signature pattern — 20 different species of bacteria that were present in either higher or lower amounts in people who have this condition, compared to those who don’t. The relationship turned out to be so close that they could predict, with nearly 90 per cent accuracy, whether someone had fibromyalgia or not, simply by analysing their poo samples, reported the journal Pain.

The team plan further research to see if gut bacteria are implicated in other conditions, such as chronic headaches or lower back pain.

Quite how bacteria might cause pain is unclear, but one possibility is that they interact with parts of our immune system and cause widespread inflammation — particularly in our central nervous system, where pain signals are transmitted to the brain.

The hope is that this discovery will lead to new treatments, which might include a faecal transplant — where a patient’s gut microbes are largely replaced by microbes collected from healthy donors.

Could Medicinal Cannabis Help? 

Other potential treatments include medicinal cannabis. The cannabis plant produces a range of chemicals, including some that have been shown to block pain signals.

They do this by tapping into our endocannabinoid system, which naturally releases cannabis-like substances into our blood that have widespread effects on our body, including pain relief.

The cannabis plant produces a range of chemicals, including some that have been shown to block pain signals

The cannabis plant produces a range of chemicals, including some that have been shown to block pain signals

The hope is that drug companies can produce properly tested, refined forms of cannabis that are effective at dealing with chronic pain, without being addictive or giving people a rush.

Currently in the UK, medicinal cannabis is licensed only for treating childhood epilepsy, adults with vomiting or nausea caused by chemotherapy and people with muscle stiffness and spasms caused by multiple sclerosis.

Tumeric Capsules Show Promise

Turmeric has been used for millennia to treat a range of health conditions. It is part of the ginger family and though you are most likely to encounter it in a curry, it is increasingly popular because of claims that it can treat everything from inflammatory bowel disease to rheumatoid arthritis. So how well do those claims stack up?

Turmeric is part of the ginger family and though you are most likely to encounter it in a curry, it is increasingly popular because of claims that it can treat everything from inflammatory bowel disease to rheumatoid arthritis

Turmeric is part of the ginger family and though you are most likely to encounter it in a curry, it is increasingly popular because of claims that it can treat everything from inflammatory bowel disease to rheumatoid arthritis

Well, in a recent study by the University of Tasmania, 70 patients with osteoarthritis in the knee were randomly allocated to either swallowing capsules containing curcumin (the active compound in turmeric), or a placebo. After 12 weeks, the curcumin group reported less pain and needed less pain medication than those taking the placebo pills. Larger trials are needed, but this is encouraging.

A Case of Mind Over Matter

Speaking of placebos, perhaps the best ‘pill’ of all might be the power of your own mind.

A few years ago I was involved in an experiment involving more than 100 people with chronic back pain, who were told they might get a placebo or a powerful new painkiller. In fact they all received a placebo, capsules containing only ground rice.

Speaking of placebos, perhaps the best ¿pill¿ of all might be the power of your own mind

Speaking of placebos, perhaps the best ‘pill’ of all might be the power of your own mind

After three weeks, more than half the patients reported a significant drop in pain and improvements in disability. Despite the fact we then told them that they had all got a placebo, many wanted to go on taking our pills.

If you want to try to harness the placebo effect, make sure you have a good relationship with your doctor, as this has been shown to produce a powerful effect.

And take a moment before you swallow your next painkiller to say to yourself, ‘this is really going to help’, because that could enhance its effectiveness.

 I’m Doing a Digital-Detox

I was shocked to see that last week I was averaging four hours a day on my phone, mainly spent doing emails or doom-scrolling the news.

But in fact I’m typical — this is precisely the amount of time we Brits spend using our mobile devices, up from three hours in 2019, according to market researcher, Statista.

Nonetheless I’ve decided it’s time for a digital detox. Studies suggest that cutting back on digital time can improve your sleep, relationships and mood.

Studies suggest that cutting back on digital time can improve your sleep, relationships and mood

Studies suggest that cutting back on digital time can improve your sleep, relationships and mood

First, decide which activity you want to reduce or eliminate. For me that’s the hours I spend reading the news, so l will cut back.

Then set a goal: mine is to halve my smartphone use. Ironically, the great thing about smartphones is they can tell you exactly how long you spend on them each week, so I’ll be able to track how I’m doing.

Finally, encourage your family to tell you off if they see you using your smartphone, especially when eating meals or watching TV together.

My nearest and dearest are particularly keen to help out with this.

 Why Larks Are Brighter Than Night Owls

Some people are larks who leap out of bed in the morning, raring to go. Others are owls and need an alarm clock to get them going.

There’s evidence that these differences are rooted in our genes, but they also depend on our age. Most of us are owl-like as teenagers, but start to display lark-like tendencies as we get older.

My wife, Clare, is an exception. Despite being 61, she will still quite happily stay up working until the small hours, while I prefer to head for bed soon after 10pm.

As a lark I was delighted by a new report (which of course I waved in front of Clare) claiming that larks are cleverer than owls, at least when it comes to verbal abilities. In a study at the University of Ottawa, 61 people underwent tests that measured things such as short-term memory. Participants also wore devices to monitor their sleeping patterns.

Most of us are owl-like as teenagers, but start to display lark-like tendencies as we get older

Most of us are owl-like as teenagers, but start to display lark-like tendencies as we get older

Previous studies have found that owls, on the whole, are more extrovert, do better in IQ tests and earn more.

But the researchers behind this study found that ‘once you account for key factors including bedtime and age… the opposite [is] true, that morning types tend to have superior verbal ability’.

This is consistent with another study that found larks tend to do better at school. Probably because they are more likely to be awake and lively in the mornings.

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