Categories
Blog

A Study on How Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome

NexGen Hyperbaric Doctors For Hyperbaric Treatment

A rheumatologist generally diagnoses fibromyalgia when a patient presents with a history of pain that affects all quadrants of the body for a period of three months. The examination also needs to show a pain response from digital pressure in at least 11 out of 18 allogenic “tender” points.

Fibromyalgia is characterized by widespread musculoskeletal pain, difficulty sleeping, mood swings, and memory issues. This condition affects the productivity of patients’ lives, including their careers and relationships.

Different treatments for fibromyalgia exist, including medications like anti-depressants and counseling. Unfortunately, these treatments are only partially effective. However, clinical trials in the past decade have shown that patients respond to hyperbaric oxygen therapy (HBOT) for fibromyalgia.

At NexGen Hyperbaric clinics, we provide state-of-the-art HBOT treatments for a full range of medical conditions, including fibromyalgia, in UHMS-accredited facilities in Edwards, CO. Our team monitors emerging research on HBOT and fibromyalgia; below, we share some of the most promising recent research.

What Is Fibromyalgia?

Fibromyalgia, a persistent and debilitating disorder, is a type of sensitization of the central nervous system related to abnormal brain activity affecting 2-4% of the total population, 90% of whom are female. FMS has many symptoms that can vary across patients. Patients often report experiencing:

  • Chronic widespread pain, especially musculoskeletal pain
  • Fatigue and sleep disturbance
  • Protracted muscle spasms
  • Intestinal disorder
  • Overall weakness in muscles and the limbs
  • Muscle twitching
  • Palpitations
  • Allodynia
  • Diffuse tenderness
  • Depression and anxiety
  • Reduced information-processing speed

A Challenging Syndrome

Instead of a single cause, evidence suggests many factors that can either cause or exacerbate symptoms. For example, an infection like Lyme disease, a viral illness, or a traumatic brain injury may set off FMS. In the 2021 International Journal of Molecular Sciences, Rosalba Siracusa et al. describe various causes of the chronic pain as “peripheral, central, cognitive-emotional and interpersonal.”

Likewise, disputes exist regarding the diagnostic criteria for establishing fibromyalgia cases. The American College of Rheumatology (ACR) first classified fibromyalgia in 1990. In addition to understanding it as a central sensitization phenomenon, researchers in recent years have attributed the pathogenesis of fibromyalgia to other factors, including psychosocial, endocrine, inflammatory, immune, and genetic contributors.

The medical community lacks strong evidence-based guidelines for fibromyalgia treatment. Primarily, the PCPs who treat most cases utilize a mixture of patient education, referral to cognitive behavioral therapy, physical therapy, and pharmacological therapy.

While many other treatments exist, our goal at NexGen Hyperbaric has been to look at hyperbaric oxygen therapy (HBOT) and its usefulness in treating fibromyalgia and its related symptoms. A 2015 study on this topic by a large Israeli team led by Shai Efrati emerged from a controversy among rheumatologists as to whether fibromyalgia is primarily associated with abnormal pain processing in the brain or is a type of peripheral small fiber inflammation.

The Approach

The motivator behind the 2015 Israeli study was the hypothesis that hyperbaric oxygen therapy (HBOT) could correct the abnormal brain function underlying the symptoms of FMS patients. Earlier trials had shown that HBOT could induce neuroplasticity, repairing chronically impaired brain functions in post-stroke patients and mild Traumatic Brain Injury (mTBI) patients.

The researchers hoped to show that HBOT would facilitate the fibromyalgic brain to rectify chronically damaged brain functionality. Researchers randomly assigned 48 female patients, ages 21-67, to two groups: a treated group and a crossover group.

Study endpoints included assessments of

  • Assessment of brain activity according to SPECT imaging
  • Tender point count
  • Pain threshold and symptom severity
  • Functional impairment
  • Quality of life

HBOT and Fibromyalgia

Researchers evaluated all patients at baseline and after 2 months of HBOT (or 2 months of no treatment for the crossover group). Then, the crossover group received evaluation after a subsequent 2-month treatment with HBOT.

Researchers used SPECT scans and HBOT protocols.

Researchers evaluated many issues regarding each patient during and following treatment, including psychological distress, the ability to perform tasks like cleaning and driving, and overall quality of life.

Methods

The study quantitatively evaluated participants’ pain levels using tender points as criteria. A rheumatologist blind to the study applied manual pressure to 18 tender points using thumb palpation. The rheumatologist applied 4 kg per cm2 to each tender point.

The rheumatologist then used a Chatillon dolorimeter to measure pain at 13 point sites (nine tender points and four control sites).

For functional impairment, the study used a Fibromyalgia Impact Questionnaire to measure the participants’ ability to perform everyday tasks.

A symptom checklist (SCL-90) examined psychological distress, including items like interpersonal sensitivity, phobic anxiety, obsession-compulsion, and paranoid ideation.

Another questionnaire (SF-36) measuring quality of life, and the study used SPECT scans for brain functional imagining.

Research, HBOT, and Fibromyalgia

At baseline, the two groups had very close mean scores for both measures. The crossover group maintained the same general score after the control period that it had at baseline. However, the HBOT treatments of both groups (at different stages in the trial) led to “statistically significant improvements in the mean scores of both the dolorimeter thresholds and of the number of tender points,” with a significant reduction in the number of tender points.

Important to note is that while researchers found a high patient-to-patient variability in the dolorimeter thresholds, their measure was the impact of the HBOT on each patient’s change relative to the base value. The analysis also looked at the relative changes in the number of tender points and how HBOT treatment affected those changes for each patient and for each group as a whole.

The results of other endpoint measures were also promising. The physical functioning score significantly improved following HBOT in the treated group (mean change was 1.31±0.99, p < 0.001) as well as the crossover group after HBOT (mean change was 1.02±0.92, p = 0.05), as did the psychological distress score:

Treated group (mean change 1.10±0.79, p < 0.01)

Crossover group after HBOT (mean change 1.29±0.76, p = 0.05)

The quality of life score also reflected the positive impact of HBOT treatment:

Treated group (mean change 0.34±0.33, p < 0.01)

Crossover group after HBOT (mean change 0.23±0.39, p = 0.05)

In terms of reliance on pharmaceuticals to manage pain, the study found a significant decrease in the fibromyalgia patients’ use of analgesic medications following HBOT in both groups.

Brain SPECT Imaging

Another significant finding stemmed from the SPECT images, which researchers performed for all patients, with two imagings for the treated group and three for the control (crossover) group. Seven of the 48 patients did not show significant improvement.

The researchers calculated

  • the relative change in the SPECT measured brain activity, Rchange(i,n), during each phase
  • the average changes, (n), for the 41 patients (out of 48) from both groups that showed significant improvement in FMS symptoms following HBOT treatment

Earlier studies had shown that FMS patients had reduced brain activity in BAs in the frontal cortex and elevated activity in the posterior brain. Following the HBOT period for each group in this study, improved patients (41 out of 48) exhibited elevated activity of Brodmann Areas (BAs) in the frontal lobe (25L+R, 10L+R, 47R, 45R, 11R, 9R, 8R) and in BA 38L, and reduced activity of BAs in the posterior brain (7L+R, 37L, 36L, 17L).

Following HBOT, new SPECT images showed that patients had less activity in their posterior brain alongside higher activity in their frontal cortex.

Thus, the findings of the 2015 Israeli study of the effects of HBOT on FMS patients affirm that hyperbaric oxygen therapy is associated with changes in the brain activity of specific BAs known to have been abnormal in FMS patients.

Moreover, patients in both groups following HBOT treatment improved with regard to:

  • Overall quality of life
  • Completing physical functions
  • Reliance on pharmaceuticals
  • Psychological distress
  • Reduction in somatosensory cortex brain function

Additional Read: The Benefits of HBOT for Post-Traumatic Stress Disorder (PTSD)

Hyperbaric Oxygen Therapy For Fibromyalgia Syndrome From NexGen Hyperbaric

Contact NexGen in Edwards, CO, at 888-567-4302 to discover more about how hyperbaric oxygen therapy can treat fibromyalgia. Our team has provided patients with hyperbaric oxygen treatments for over ten years.