EP060 Pain begins in the gut? Probiotic interventions in chronic pain management

<h3>Background and Aims</h3> Chronic pain is increasingly understood as a biopsychosocial condition involving neuroinflammation, central sensitization and immune dysregulation. The gut-brain axis has emerged as a key regulator of pain perception. Dysbiosis and disruption of intestinal permeability may amplify nociceptive signaling, influencing both visceral and somatic pain syndromes. Probiotic-based interventions have demonstrated promising anti-inflammatory and neuromodulatory effects in preclinical and clinical models of pain. This study aims to summarize current evidence and propose a targeted probiotic protocol for chronic pain management. <h3>Methods</h3> A structured review of recent publications (2010–2024) was conducted using PubMed, Scopus, and full-text clinical trials evaluating probiotics in pain modulation. Strain-specific effects, mechanisms, dosage, and duration were extracted and compared. Clinical relevance was assessed based on outcomes in patients with fibromyalgia, irritable bowel syndrome, and neuropathic pain. <h3>Results</h3> Probiotic interventions can influence pain through multiple mechanisms, including modulation of microglia, reduction of systemic cytokines (IL-6, TNF-α), enhancement of GABA signaling, and reinforcement of mucosal barrier integrity. Certain strains, particularly Bifidobacterium longum, Lactobacillus rhamnosus GG, and Lactobacillus reuteri DSM 17938, demonstrate consistent analgesic potential. Table 1 summarizes evidence-based recommendations for clinical application, including strain, dose, duration, and proposed indication. <h3>Conclusions</h3> Targeted probiotic interventions may reduce inflammation and improve pain control in chronic pain patients. Based on current evidence, we propose the development of a probiotic (table 2), a multi-strain formulation for use in specialized pain units. Administration should begin 2–4 weeks before initiating intensive treatment and continue for at least 8–12 weeks. Integration with dietary modulation and psychological support may enhance outcomes. Further clinical trials are required to validate efficacy and define optimal protocols in multidisciplinary pain management.