{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:51:42Z","timestamp":1784224302406,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Advanced Pain Discovery Platform (APDP) and the Medical Research Council","award":["MR\/W026813\/1"],"award-info":[{"award-number":["MR\/W026813\/1"]}]},{"DOI":"10.13039\/501100012041","name":"Versus Arthritis","doi-asserted-by":"publisher","award":["23139"],"award-info":[{"award-number":["23139"]}],"id":[{"id":"10.13039\/501100012041","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UKRI","doi-asserted-by":"crossref","award":["MR\/Y010175\/1"],"award-info":[{"award-number":["MR\/Y010175\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute of Health and Care Research Nottingham Biomedical Research Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Emerging evidence links the gut microbiome to chronic pain processing. Inulin, a prebiotic fibre, modulates the gut microbiome, while physiotherapy-supported exercise (PSE) improves pain and function. We evaluated the effects of inulin supplementation with and without PSE on knee osteoarthritis (OA) pain. Methods: In a 2 \u00d7 2 factorial RCT, 117 community-dwelling adults with knee OA received 6 weeks of: (A) 20 g\/day inulin, (B) digital PSE (Joint Academy\u2122), (C) inulin +PSE, or (D) 10 g\/day maltodextrin. Primary outcome: pain (Numerical Rating Scale). Secondary: 30 s sit-to-stand (30-CST), timed up and go (TUG), grip strength, and quantitative sensory testing. Serum short-chain fatty acids (SCFAs) and glucagon-like peptide-1 (GLP-1) were measured. The study was not powered to detect synergistic interaction. Results: A total of 117 participants (58.1% female; mean \u00b1 SD age = 67.5 \u00b1 9.4 years; BMI = 29.5 \u00b1 5.3 kg\/m2; NRS = 3.96 \u00b1 2.67) completed the trial. Pain improved with inulin (baseline-adjusted between-group mean difference (\u0394) = \u22121.11 [95%CI \u22122.18, \u22120.04], p = 0.045) and PSE (\u0394 = \u22121.55 [95%CI \u22122.52, \u22120.58], p = 0.002) compared to placebo, with no synergistic effect. PSE improved TUG (p = 0.02) and 30-CST (p = 0.0004), while inulin improved grip strength (p = 0.002), pressure pain thresholds (p = 0.009) and temporal summation (p = 0.025) compared to placebo and had significantly lower dropout rates (3.6%) compared with PSE (21% p &lt; 0.01). Only inulin increased SCFA butyrate (p = 0.0248) and GLP-1 (p = 0.0109), and higher GLP-1 was associated with improved grip strength, suggesting a gut\u2013muscle link. Conclusions: Inulin and PSE each produced meaningful pain reductions. Only inulin improved pain sensitivity and grip strength, the latter paralleled by increased GLP-1, and had much higher rates of retention compared to PSE.<\/jats:p>","DOI":"10.3390\/nu18050714","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:19:23Z","timestamp":1771935563000},"page":"714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of Prebiotic Supplementation With and Without Physiotherapy on Pain and Pain Sensitivity in People with Knee Osteoarthritis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5976-9047","authenticated-orcid":false,"given":"Afroditi","family":"Kouraki","sequence":"first","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7577-4658","authenticated-orcid":false,"given":"Susan","family":"Franks","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Vijay","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kurien","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"},{"name":"Division of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4100-8343","authenticated-orcid":false,"given":"Moira A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"The David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham NG7 2TQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3365-0144","authenticated-orcid":false,"given":"Stephanie L.","family":"Smith","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Smith","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-7957","authenticated-orcid":false,"given":"Anthony","family":"Kelly","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1141-4471","authenticated-orcid":false,"given":"Ana M.","family":"Valdes","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK"},{"name":"Arthritis UK Pain Centre, University of Nottingham, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1056\/NEJMcp1903768","article-title":"Osteoarthritis of the Knee","volume":"384","author":"Sharma","year":"2021","journal-title":"N. 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