This chapter studies the relationship between spine and joint pain and the composition of gut microbiota. It will discuss the significance of the microbiome in digestion, immune, and inflammatory functions. Topics covered include gut-spine-joint axis and the gut-brain axis and explains how gut dysbiosis leads to pain through cytokine release and immune system disturbances. Dietary impact on the gut and recommendations for culinary medicine that promotes an anti-inflammatory diet to restore the microbiota homeostasis will also be discussed.