By Xinxin Chen, MM; Jiuhong You, MM; Hui Ma, MM; Mei Zhou, MM; Cheng Huang, MD
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain and other symptoms including fatigue, sleep disturbances, and cognitive dysfunction. Current treatments like medications, exercise, and behavioral therapies have limited effectiveness and tolerability[1]Chen X, You J, Ma H, Zhou M, Huang C. Efficacy and safety of hyperbaric oxygen therapy for fibromyalgia: a systematic review and meta-analysis. BMJ open. 2023 Jan 1;13(1):e062322..
Hyperbaric oxygen therapy (HBOT), which involves breathing pure oxygen in a pressurized chamber, has anti-inflammatory and tissue oxygenating effects that could benefit fibromyalgia. This systematic review and meta-analysis assessed the efficacy and safety of HBOT for fibromyalgia.
About Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen inside a sealed chamber at pressures higher than normal atmospheric pressure. During Hyperbaric oxygen therapy, patients breathe oxygen at pressures typically between 1.5-3 times greater than sea-level pressure. At these elevated pressures, the plasma carries more dissolved oxygen and tissue oxygen levels can increase substantially.
HBOT originally emerged as a treatment for decompression sickness in divers, but now has approved uses for conditions like carbon monoxide poisoning, air embolism, and wound healing. The high oxygen levels are thought to reduce inflammation, promote angiogenesis, and stimulate tissue regeneration and repair. Hyperbaric oxygen therapy may also enhance oxygen delivery to ischemic tissues.
Hyperbaric Oxygen Therapy and Fibromyalgia
For fibromyalgia, typical HBOT protocols involve pressurized oxygen at 1.5-2.5 atmospheres absolute (ATA) for 60-90 minutes per session, with multiple sessions per week over several weeks. Patients lie in a transparent chamber and breathe pure oxygen through a mask or hood. The air pressure is slowly increased to therapeutic levels over 5-10 minutes as the chamber is pressurized. After the treatment period, decompression occurs gradually over 15-30 minutes.
Several mechanisms may explain potential Hyperbaric oxygen therapy benefits in fibromyalgia. By increasing tissue oxygen levels, HBOT could improve oxygen delivery to muscles and repair mitochondrial dysfunction linked to fibromyalgia symptoms. HBOT may reduce neuroinflammation and glial activation implicated in central sensitization and pain amplification.
The high oxygen levels also trigger vasoconstriction that could alleviate local tissue ischemia associated with tender points. Furthermore, Hyperbaric oxygen therapy releases endogenous opioids and activates opioid receptors which may raise pain thresholds. Through such effects, HBOT could break cycles of tissue hypoxia and nociceptive signaling to alleviate widespread pain and other fibromyalgia manifestations.
Study Description
The authors systematically searched major databases through October 2022 for clinical trials examining Hyperbaric oxygen therapy in fibromyalgia patients meeting standard diagnostic criteria. Outcomes of interest included core fibromyalgia symptom domains like pain, tenderness, fatigue, function, and patient global impression. Study quality and risk of bias were assessed using standard tools. Meta-analysis was performed for pain, with other outcomes summarized descriptively.
Nine studies with 288 patients were included. Meta-analysis of 3 randomized trials found a large effect of HBOT in reducing pain versus control interventions (standardized mean difference -1.56, 95% CI -2.18 to -0.93, p<0.001). Most studies also reported significant HBOT benefits for tender points, fatigue, function, patient global impression, and sleep. Adverse events, mainly mild barotrauma, occurred in 24% of patients receiving Hyperbaric oxygen therapy, with 7% withdrawing due to intolerance.
Individual Studies
Yildiz et al. (2004) conducted a randomized trial of HBOT in 50 female fibromyalgia patients. The treatment group (n=26) received 15 sessions of HBOT at 2.4 ATA over 3 weeks. The control group (n=24) received sham therapy with room air at 1 ATA. HBOT significantly decreased the number of tender points and increased pain threshold compared to sham therapy. Pain scores on a visual analog scale (VAS) also improved in the Hyperbaric oxygen therapy group.
Efrati et al. (2015) performed an open-label trial of HBOT in 59 women with fibromyalgia. The treatment group (n=27) received 40 sessions of HBOT at 2.0 ATA over 8 weeks. After HBOT, tender point count reduced by 53% and pain threshold increased by 47%. Mean pain VAS scores decreased from 9 to 3 out of 10. Hyperalgesia and quality of life assessed by the Fibromyalgia Impact Questionnaire improved as well. 13 patients reported mild barotrauma symptoms like ear discomfort.
Hadanny et al. (2018) conducted a randomized trial comparing HBOT to psychotherapy in 30 fibromyalgia patients. The HBOT group (n=15) received 60 sessions at 2.0 ATA over 12 weeks. Hyperbaric oxygen therapy reduced widespread pain index (WPI) scores by 41% and improved Fibromyalgia Impact Questionnaire and quality of life scores. 12 patients developed mild barotrauma managed by equalizing middle ear pressure. 1 patient had transient headaches.
Izquierdo-Alventosa et al. (2020) performed a randomized trial of HBOT versus exercise therapy in 33 women with fibromyalgia. The HBOT group (n=17) received 40 sessions at 1.45 ATA over 8 weeks. HBOT significantly decreased pain VAS scores and increased pain threshold compared to exercise. Hyperbaric oxygen therapy was well-tolerated without adverse events.
Quality of Evidence
Overall, the quality of evidence for Hyperbaric oxygen therapy effects on fibromyalgia pain was moderate. Limitations were the small number of randomized trials and clinical heterogeneity.
The findings suggest HBOT could effectively improve core fibromyalgia symptom domains like pain and tenderness, with reversible side effects. Future large randomized trials are needed to confirm optimal HBOT protocols balancing efficacy and safety. If effective, HBOT could provide a non-pharmacological treatment option for fibromyalgia patients not responding adequately to standard therapies.
Conclusion
Multiple studies found HBOT at ~2 atmospheres reduced tender point count and clinical pain scores by 40-50% in fibromyalgia patients. Hyperbaric oxygen therapy also increased pain pressure thresholds. Some reversible side effects like ear discomfort and barotrauma occurred, but were managed by pressurization protocols. The results indicate HBOT can provide significant analgesia in fibromyalgia.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Chen X, You J, Ma H, Zhou M, Huang C. Efficacy and safety of hyperbaric oxygen therapy for fibromyalgia: a systematic review and meta-analysis. BMJ open. 2023 Jan 1;13(1):e062322. |
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