Fibromyalgia

Written By Elizabeth Gaffney

HBOT for Fibromyalgia

Introduction

Hyperbaric oxygen therapy (HBOT), in which the patient breathes pure oxygen in a pressurised chamber, may have wide-ranging benefits for patients with fibromyalgia, including decreased pain and improved sleep, cognitive function and quality of life. HBOT is associated with enhanced oxygen delivery, reduced inflammation and increased neuroplasticity and mitochondrial function. There is robust clinical evidence supporting HBOT as an adjunctive treatment for fibromyalgia.

Mechanisms of Action of HBOT

HBOT may be beneficial in the treatment of fibromyalgia by enhancing oxygen delivery to tissues. During HBOT, patients are treated with pure oxygen in a chamber in which the pressure is higher than atmospheric pressure (2 ATA) for 1.5 hours for multiple sessions. The beneficial effects of HBOT on fibromyalgia are multifaceted and involve several distinct mechanisms.

1. Enhanced oxygenation: HBOT increases the amount of oxygen dissolved in the blood, significantly improving oxygen delivery to tissues (Cannellotto et al., 2024), including the brain and muscles. Enhanced oxygenation can help mitigate the hypoxic conditions and reduced oxygen consumption that may be observed in fibromyalgia patients (Lund et al., 1986; Villafaina et al., 2023).

2. Reduction of neuroinflammation: HBOT has anti-inflammatory effects that can reduce the levels of pro-inflammatory cytokines in the central nervous system (Ahmadi & Khalatbary, 2021). By modulating the inflammatory response, HBOT may alleviate the chronic pain and cognitive dysfunction associated with fibromyalgia.

3. Neuroplasticity and pain modulation: HBOT may promote neuroplasticity (Efrati et al., 2013) and enhance the brain's capacity to modulate pain and reduce hypersensitivity.

4. Mitochondrial function: Fibromyalgia has been linked to mitochondrial dysfunction (Cordero et al., 2010). HBOT enhances mitochondrial function by improving oxygen availability, which can boost ATP production and reduce oxidative damage (Cannellotto et al., 2024). 

5. Improved immune function: HBOT has immunomodulatory effects (Ortega et al., 2021), which may help in managing fibromyalgia symptoms. By improving the immune response and reducing chronic low-grade inflammation, HBOT can contribute to overall symptom relief.

Benefits of HBOT for Patients with Fibromyalgia

HBOT is generally well tolerated, and serious side effects are rare (Camporesi, 2014). Patients with fibromyalgia may experience a range of benefits from HBOT that can significantly improve their symptoms and quality of life.

1. Pain reduction: One of the primary benefits of HBOT for fibromyalgia patients is the reduction of pain (Chen et al., 2023). By addressing neuroinflammation and improving oxygenation, HBOT can alleviate chronic pain and enhance patients’ quality of life.

2. Enhanced sleep quality: Sleep disturbances are a common symptom of fibromyalgia, and HBOT improves sleep quality in patients by reducing pain and modulating neuroinflammatory processes (Curtis et al., 2021; Chen et al., 2023).

3. Improved cognitive function: HBOT may rectify abnormal brain activity in fibromyalgia patients (Efrati et al., 2013) and decrease the symptoms associated with “fibro fog”.

4. Increased energy levels: HBOT can boost mitochondrial function and energy production, leading to increased stamina and reduced fatigue (Chen et al., 2023).

5. Overall symptom relief: By addressing multiple underlying mechanisms of fibromyalgia, HBOT can provide comprehensive symptom relief. Patients may experience improvements in pain, sleep, cognitive function, and overall well-being, leading to a better quality of life (Chen et al., 2023).

Clinical Evidence Supporting HBOT for Fibromyalgia

Several clinical studies, including controlled trials and meta-analyses, indicate that HBOT is an effective treatment option for fibromyalgia.

1. Systematic reviews and meta-analyses: Several systematic reviews and meta-analyses have consolidated the evidence for HBOT in treating fibromyalgia and concluded that HBOT (typically 100% O2, 2 ATA, 90 mins, 40–60 sessions) reduces fibromyalgia symptoms, particularly pain and fatigue (Cao et al., 2023; Chen et al., 2023; Kulshreshtha et al., 2024).

2. Randomised controlled trials: A number of RCTs indicate that HBOT (100% O2, 1.4–2.4 ATA, 90 mins, 15–60 sessions) can benefit FMS patients (Cao et al., 2023). A randomised controlled trial by Efrati et al. (2015) investigated the effects of HBOT (100% O2, 2 ATA, 90 mins, 40 sessions) on fibromyalgia patients. The HBOT group showed significant improvements in pain perception, quality of life, and brain activity related to pain processing. In another study (Yildiz et al., 2024), HBOT (100% O2, 1.45 ATA, 90 mins, 15 sessions) led to a significant reduction in tender points and pain scores and a significant increase in pain threshold patients with fibromyalgia. Other trials have shown similar benefits of HBOT in the treatment of fibromyalgia (Hadanny et al., 2018; Izquierdo-Alventosa et al., 2020).

3. Neuroimaging studies: Neuroimaging studies have provided insights into the mechanisms by which HBOT may benefit fibromyalgia patients. HBOT (100% O2, 2 ATA, 90 mins, 40–60 sessions) may lead to increased brain activity in areas related to pain modulation and cognitive function, as well as improved brain functionality and microstructure, in fibromyalgia patients (Efrati et al., 2015; Hadanny et al., 2018; Boussi-Gross et al., 2024). A study on neuromuscular efficiency indicated that 20 sessions of HBOT at 2.4 ATA improved the ability of the central motor command to generate the same maximum voluntary contraction with fewer recruited fibres, suggesting that muscle fatigue is not solely a muscular problem in fibromyalgia (Casale et al., 2019).

Conclusion

HBOT offers a promising adjunctive treatment for fibromyalgia, addressing multiple underlying mechanisms such as enhanced oxygenation, reduced neuroinflammation, improved neuroplasticity, and better mitochondrial function. Clinical evidence, including randomised controlled trials, pilot studies, and neuroimaging research, supports the potential benefits of HBOT in reducing pain, enhancing sleep quality, improving cognitive function, and increasing energy levels in fibromyalgia patients. HBOT may be an effective tool in the management of fibromyalgia.

References

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  • Boussi-Gross, R., Catalogna, M., Lang, E., Shamai, Z., Ablin, J. N., Aloush, V., ... & Efrati, S. (2024). Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial. Scientific Reports, 14(1), 11599.

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  • Chen, X., You, J., Ma, H., Zhou, M., & Huang, C. (2023). Efficacy and safety of hyperbaric oxygen therapy for fibromyalgia: a systematic review and meta-analysis. BMJ Open, 13(1), e062322.

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  • Efrati, S., Fishlev, G., Bechor, Y., Volkov, O., Bergan, J., Kliakhandler, K., ... & Golan, H. (2013). Hyperbaric oxygen induces late neuroplasticity in post stroke patients-randomized, prospective trial. PloS One, 8(1), e53716.

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  • Hadanny, A., Bechor, Y., Catalogna, M., Daphna–Tekoah, S., Sigal, T., Cohenpour, M., ... & Efrati, S. (2018). Hyperbaric oxygen therapy can induce neuroplasticity and significant clinical improvement in patients suffering from fibromyalgia with a history of childhood sexual abuse—randomized controlled trial. Frontiers in Psychology, 9, 2495.

  • Izquierdo-Alventosa, R., Inglés, M., Cortés-Amador, S., Muñoz-Gómez, E., Mollà-Casanova, S., Gimeno-Mallench, L., ... & Serra-Añó, P. (2024). Effects of a low-pressure hyperbaric oxygen therapy on psychological constructs related to pain and quality of life in women with fibromyalgia: A randomized clinical trial. Medicina Clínica (English Edition), 162(11), 516–522.

  • Kulshreshtha, P., Neyaz, O., Begum, S., Yadav, R. K., & Deepak, K. K. (2024). Assessment of the efficacy and safety of hyperbaric oxygen therapy on pain in patients with fibromyalgia: A systematic review and meta-analysis of randomised controlled studies. Journal of Medical Evidence, 5(1), 40–54.

  • Lund, N., Bengtsson, A., & Thorborg, P. (1986). Muscle tissue oxygen pressure in primary fibromyalgia. Scandinavian Journal of Rheumatology, 15(2), 165–173.

  • Ortega, M. A., Fraile-Martinez, O., García-Montero, C., Callejón-Peláez, E., Sáez, M. A., Álvarez-Mon, M. A., ... & Canals, M. L. (2021). A general overview on the hyperbaric oxygen therapy: Applications, mechanisms and translational opportunities. Medicina, 57(9), 864.

  • Villafaina, S., Tomas-Carus, P., Silva, V., Costa, A. R., Fernandes, O., & Parraca, J. A. (2023). The behavior of muscle oxygen saturation, oxy and deoxy hemoglobin during a fatigue test in fibromyalgia. Biomedicines, 11(1), 132.

  • Yildiz, Ş., Kiralp, M. Z., Akin, A., Keskin, I., Ay, H., Dursun, H., & Cimsit, M. (2004). A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. Journal of International Medical Research, 32(3), 263–267.

Elizabeth Gaffney https://www.sourceprojects.co
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