After analyzing over 40 probiotics across 69 trials, we’ve identified the most promising probiotics for managing pain in IBS. Our dataset (below) is ordered based on an automated scoring system, which we further refined using additional criteria (below) to select our top choices. Here are the results of our findings.

Our Top Choice(s)

Lactospore

A study on Lactospore in adults with diarrhea-predominant IBS (IBS-D) found that it significantly reduced abdominal pain and gastrointestinal (GI) discomfort. Participants reported a 68.1% decrease in pain scores, which was highly significant (p=0.0001). GI discomfort also saw notable improvements, with statistically significant reductions between visits 2 and 4 (p < 0.01) and a large effect size of 2.5. (1) A later study in adults with major depressive disorder and IBS showed similar benefits. Participants reported improvements in GI symptoms, as measured by the Gastrointestinal Discomfort Questionnaire (GI-DQ), with a moderate effect size of 0.68. (2) Overall, Lactospore earned a composite score of 1.46 for its ability to relieve IBS-related abdominal pain and discomfort, securing its spot as our #1 choice for pain relief in IBS.

De Simone Formulation 

The De Simone formulation, previously known as VSL#3, has shown promise in managing abdominal pain in IBS. While some studies, such as those by Kim HJ et al. (2003, 2005) (3) (4) and Tuteja AK et al., (5) did not find significant differences in abdominal pain between the probiotic group and placebo, other research has produced more encouraging results. For example, Guandalini et al. found that patients taking the probiotic experienced a significant reduction in abdominal pain compared to those on placebo, with a large effect size (Cohen’s d = 2.48, p < 0.05). (6) Similarly, Michail et al. reported greater pain relief in the probiotic group, measured using the GSRS-IBS scale, compared to the placebo group (p = 0.008, Cohen’s d = 1.18). (7) Supporting these findings, Wong RK et al. showed that the probiotic significantly increased the threshold at which rectal pressure caused pain (from 38.38 to 42.47 mm Hg, p < 0.05), and this increase was correlated with less pain over time (r = 0.45, p = 0.052). (8) When all studies are considered together, the overall weighted mean effect size for the De Simone formulation’s impact on abdominal pain was strong (1.43), earning it the #2 spot in our rankings for abdominal pain reduction. 

Unique IS-2 

In two studies, Bacillus coagulans Unique IS-2 demonstrated significant improvements in pain relief and abdominal discomfort for individuals with IBS. The first study, conducted by Sudha et al. in children with IBS, showed that 81.94% of participants in the probiotic group experienced over 50% pain relief after 4 weeks, which increased to 93.06% by 8 weeks. Additionally, abdominal discomfort scores dropped by 85.29%, with an impressive effect size of 1.88, indicating strong improvement. (9) Similarly, a second study in adults with IBS by Madempudi et al. reported a 58.5% reduction in pain intensity, with 84.91% of participants achieving at least 50% pain relief by week 8. Abdominal discomfort also saw a significant decrease, with a 63.9% reduction and a large effect size of 1.73. (10) These results have earned Bacillus coagulans Unique IS-2 the #3 spot in our rankings for abdominal pain reduction.

I.31 

A study on I.31 in individuals with IBS-D and IBS-M reported that 38.9% of participants experienced pain relief, with a large effect size (Cohen’s d = 1.33, p < 0.05). (11) Despite the small sample size, these results were promising, placing I.31 at #4 in our rankings.

DDS-1

In a study involving adults with IBS, 52.3% of those taking DDS-1 saw more than a 30% reduction in abdominal pain. By day 42, pain severity decreased by 48.27%, and pain duration dropped by 47.61%, both with large effect sizes (Cohen’s d = 0.93 and 0.90). (12) These results earned DDS-1 the #5 spot for abdominal pain relief.

Honorable Mentions:

Paraghurt

A randomized, placebo-controlled trial on Paraghurt in adults with IBS suggested potential benefits for abdominal pain, with an effect size of 1.29. (13) However, due to limitations in the study’s design, such as dosing information without CFU content information, Paraghurt earns an honorable mention for pain relief.

Bio-Kult (Multi-Strain)

In a placebo-controlled trial involving people with IBS-D, Bio-Kult significantly reduced abdominal pain. By the end of month 4, pain scores dropped by 69% from baseline, with a moderate effect size of 0.72 (p < .001).(14) This significant reduction in pain earned Bio-Kult an honorable mention in our list for abdominal pain relief.

LGG

Two studies found LGG promising for children with functional bowel disorders (FBDs), including IBS. In one study, 33% of the LGG group became pain-free compared to 5% in the placebo group (p = 0.029). (15)  Another study found that 79% of children taking LGG reduced pain episodes by weeks 5-12 (p = 0.004). (16) LGG earns an honorable mention for improving pain in IBS-related conditions.

BGN4 x AD011 x AD031 x IBS041 (Multi-Strain)

In a placebo-controlled trial, 8 weeks of treatment with this multi-strain probiotic led to a 63.4% reduction in pain scores, significantly greater than in the placebo group (p = 0.045; effect size 0.69). (17) A subgroup analysis showed even greater reductions for patients with non-constipated forms of IBS, earning it an honorable mention for pain relief.

Our Criteria

The probiotics in our full database (below) are automatically ranked based on their 1) effect size for pain relief, followed by 2) effect size for overall IBS symptoms (‘Global IBS Symptoms’), and finally by 3) the quality of evidence from the studies.

For this summary, we selected our top choices based on these rankings, along with the following additional criteria: 

• Evidence Quality Score: We only included probiotics backed by studies with an evidence quality score of 75% or higher.
• Effect Size: Only probiotics that demonstrated a moderate to high effect size (>0.5) for pain relief made the cut.
• Clear Dosing Information: Only probiotics with clear and reliable dosing data were included.
• Commercial Availability: Probiotics needed to be commercially available to consumers.

No Direct Comparisons

It’s important to note that there are no direct comparisons between the probiotics in our database across identical study methods, so we can’t definitively rank one probiotic as superior to another. The probiotics mentioned above have shown promise for pain relief in IBS, but as with all probiotic supplements, always consult your healthcare provider before starting.

* Population values represent the per-protocol population size from studies specifically assessing the parameters listed above.

* Effect sizes are reported as the weighted mean effect size across studies.

* For LGG, the population size reflects only the IBS participants from the two relevant clinical trials.

* For I.31, the population size includes only the participants from the placebo and I.31 groups.

References

1. Majeed, M., Nagabhushanam, K., Natarajan, S. et al. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study. Nutr J 15, 21 (2015). https://doi.org/10.1186/s12937-016-0140-6
2. Majeed M, Nagabhushanam K, Arumugam S, Majeed S, Ali F. Bacillus coagulans MTCC 5856 for the management of major depression with irritable bowel syndrome: a randomised, double-blind, placebo controlled, multi-centre, pilot clinical study. Food Nutr Res. 2018 Jul 4;62. doi: 10.29219/fnr.v62.1218. PMID: 29997457; PMCID: PMC6034030. 
3. Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2003;17:895–904.
4. Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil 2005;17(5):687–96. doi: 10.1111/j.13652982.2005.00695.x. 
5. Tuteja AK, Talley NJ, Murtaugh MA, Loc-Carrillo CM, Stoddard GJ, Anderson GL. Randomized, Double-Blind Placebo-Controlled Trial to Assess the Effect of Probiotics on Irritable Bowel Syndrome in Veterans With Gulf War Illness. Fed Pract. 2022 Oct;39(10):410-417. doi: 10.12788/fp.0322. Epub 2022 Oct 12. PMID: 36744017; PMCID: PMC9896367.
6. Guandalini S, Magazzu G, Chiaro A, et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled,double-blind, crossover study. J Pediatr Gastroenterol Nutr 2010;51(1):24–30.doi: 10.1097/MPG.0b013e3181ca4d95. 
7. Michail S, Kenche H. Gut microbiota is not modified by Randomized, Double-blind, Placebo-controlled Trial of VSL#3 in Diarrhea-predominant Irritable Bowel Syndrome. Probiotics Antimicrob Proteins. 2011 Mar;3(1):1-7. doi: 10.1007/s12602-010-9059-y. PMID: 22247743; PMCID: PMC3255476.
8. Wong, R.K., Yang, C., Song, GH. et al. Melatonin Regulation as a Possible Mechanism for Probiotic (VSL#3) in Irritable Bowel Syndrome: A Randomized Double-Blinded Placebo Study. Dig Dis Sci 60, 186–194 (2015). https://doi.org/10.1007/s10620-014-3299-8
9. Sudha MR, Jayanthi N, Aasin M, et al. Efficacy of Bacillus coagulans Unique IS2 in treatment of irritable bowel syndrome in children: a double blind, randomised placebo controlled study. Benef Microbes 2018;9(4):563–72. doi: 10.3920/BM2017.0129.
10. Madempudi RS, Ahire JJ, Neelamraju J, et al. Randomized clinical trial: the effect of probiotic Bacillus coagulans Unique IS2 vs. placebo on the symptoms management of irritable bowel syndrome in adults. Sci Rep 2019;9:12210. doi: 10.1038/s41598-019-48554-x.
11. Diego A. Barraza-Ortiz, Nuria Pérez-López, Víctor M. Medina-López, José I. Minero-Alfaro, Felipe Zamarripa-Dorsey, Nerina del C. Fernández-Martínez, Alberto Llorente-Ramón, Gustavo A. Ramos-Aguilar; Combination of a Probiotic and an Antispasmodic Increases Quality of Life and Reduces Symptoms in Patients with Irritable Bowel Syndrome: A Pilot Study. Dig Dis 11 May 2021; 39 (3): 294–300. https://doi.org/10.1159/000510950
12. Martoni CJ, Srivastava S, Leyer GJ. Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial. Nutrients. 2020; 12(2):363. https://doi.org/10.3390/nu12020363
13. Gade J, Thorn P. Paraghurt for patients with irritable bowel syndrome. A controlled clinical investigation from general practice. Scand J Prim Health Care 1989 Mar;7(1):23-6.
14. Ishaque SM, Khosruzzaman SM, Ahmed DS, Sah MP. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome. BMC Gastroenterol. 2018;18(1):71. doi:10.1186/s12876-018-0788-9.
15. Gawronska A, Dziechciarz P, Horvath A, et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25(2):177–84. doi:10.1111/j.1365-2036.2006.03175.x.
16. Francavilla R, Miniello V, Magista AM, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010;126(6)
    –52. doi:10.1542/peds.2010-0467.
17. Hong KS, Kang HW, Im JP, et al. Effect of probiotics on symptoms in Korean adults with irritable bowel syndrome. Gut Liver 2009; 3: 101–7.

When selecting our top probiotic picks, we ensure they are commercially available and backed by high-quality evidence, with an average score above 75% for the relevant symptom parameters. The probiotics must also demonstrate a moderate to high effect size (>0.5) for these symptoms. If there are more than five candidates, we limit our top picks to the best five based on the effect size for relevant symptoms and Global IBS symptoms, as well as evidence quality. This ensures our recommendations are practical and reliable.

When selecting our top probiotic picks, we ensure they are commercially available and backed by high-quality evidence, with an average score above 75% for the relevant symptom parameters. The probiotics must also demonstrate a moderate to high effect size (>0.5) for these symptoms. If there are more than five candidates, we limit our top picks to the best five based on the effect size for relevant symptoms and Global IBS symptoms, as well as evidence quality. This ensures our recommendations are practical and reliable.