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From the Journals

Oral Microbiome Linked to Chronic Pain in Women

Study finds poor oral health and oral pathobionts associated with pain in migraine, fibromyalgia, and abdominal disorders, suggesting possible treatment avenues.

Conexiant

A new study has identified significant associations between poor oral health, oral microbiome composition, and various pain presentations in women with central sensitization disorders, including migraine, fibromyalgia, and functional abdominal pain.

In the prospective clinical study, published in Frontiers in Pain Research, researchers from the University of Sydney and Viome Life Sciences found that women with lower oral health scores were more likely to experience migraine headaches and higher body pain scores. Several specific oral pathogenic microbes were also significantly associated with pain measures.

“Low oral health scores correlated with higher pain scores. Both were associated with higher relative abundance of oral pathobionts,” the study authors reported. “This suggests a potential role for the oral microbiota in the etiology of pain experienced by women with migraine headache and abdominal and body pain,” they added.

The researchers assessed the oral health of 158 women from New Zealand using the World Health Organization oral health questionnaire and evaluated their body pain, migraine, and abdominal pain using validated instruments. Saliva samples were analyzed using metatranscriptomics to determine relative gene abundance.

Statistical analysis revealed several significant associations:

  • Participants in the lowest quintiles for oral health were more likely to experience migraine headaches (χ² = 23.24, degrees of freedom = 4, P < .001).
  • Four oral pathogenic species—Parvimonas micra, Solobacterium moorei, Dialister pneumosintes, and Prevotella denticola—were significantly associated with bodily pain scores on the Short-Form 36 Health Survey (SF-36) after adjusting for confounders and applying false discovery rate (FDR) correction (q < .05).
  • Relative abundance of the genus Gardnerella was moderately inversely correlated with oral health scores (ρ = −0.346, q = .001).
  • Lancefieldella and Mycoplasma salivarium were associated with migraine. M salivarium remained significantly associated with migraine scores after FDR adjustment (ρ = 0.332, P < .001, q = .01).

A total of 52 oral species were significantly associated with oral health scores, of which 30 met the FDR threshold of q < .05. Among 16 inversely correlated species, Gardnerella vaginalis demonstrated the strongest negative correlation (ρ = −0.379).

The four species most strongly and inversely associated with body pain—Parvimonas micra, S moorei, D pneumosintes, and Prevotella denticola—are known oral pathogens that have been implicated in extraoral infections. These associations remained statistically significant after FDR correction in the generalized linear model.

The study found distinct oral microbiome patterns associated with specific pain conditions:

  • Migraine: Relative abundance of M salivarium was significantly higher in women with migraine compared with those without migraine (P < .001). Lancefieldella also showed significant associations with all migraine subtypes (frequent, chronic, and infrequent), with q values ranging from .07 to .09.
  • Body pain: After adjusting for age, body mass index, and added dietary sugar intake, 32 species were significantly associated with SF-36 bodily pain scores.
  • Abdominal pain: A significant difference in oral health scores was observed according to the severity of functional bowel disorder (H = 42.5, P < .001).

“The chronicity of central sensitization pain is a debilitating phenomenon that negatively impacts the quality of life. Without identifiable pathophysiology, any idiopathic pain poses notable challenges for clinicians and patients alike,” the study authors wrote.

The researchers hypothesized that poor oral health, leading to periodontitis and oral dysbiosis, may facilitate translocation of bacteria and microbial metabolites into systemic circulation. These factors may trigger heightened pain signaling and contribute to central sensitization disorders.

This study represented the first exploration of the relationship between oral health, the oral microbiome, and pain in central sensitization disorders, introducing what the researchers described as a potential “oral microbiome–nervous system axis.”

Although causal relationships couldn't be determined from the observational study, the findings may have implications for clinical strategies targeting oral health and microbial balance as modifiable factors in pain management. Future longitudinal and interventional studies are needed to confirm these associations and explore therapeutic potential.

Conflict of interest disclosures can be found in the study.