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Adult patients with traumatic brain injury-induced fibromyalgia were randomized 1:1 to receive hyperbaric oxygen therapy or pharmacological intervention.
Hyperbaric oxygen therapy (HBOT), an intervention that combines 100% oxygen with elevated atmospheric pressure, was shown to improve pain, emotional and social function, and quality of life in patients with fibromyalgia that was triggered by a traumatic brain injury (TBI), according to a study published in Plos One.1 This is in part due to increased brain activity in the frontal and parietal regions of the brain, which are linked to emotional processing and executive function.
HBOT is used to improve neuroplasticity in TBI, post-stroke, age-related cognitive decline, and post-traumatic stress disorder. Additionally, HBOT has also been shown to improve symptoms of fibromyalgia.2
“We have attempted to evaluate the therapeutic effect of HBOT on fibromyalgia patients with a clear clinical history of TBI and to compare it to the current standard pharmacological treatment,” A team of Israeli investigators explained. “Our objective was to ascertain the clinical utility of this treatment in this specific subgroup of fibromyalgia patients, as well as studying the neuroplasticity effects of the intervention through metabolic brain imaging.”
HBOT for TBI-related fibromyalgia was evaluated in the prospective randomized, single blind, controlled trial conducted at the Shamir Medical Center (SMC) in Israel. Adult patients with fibromyalgia and TBI were randomized 1:1 to receive HBOT or pharmacological intervention. The HBOT group received 60 daily sessions consisting of breathing 100% oxygen by mask at 2 absolute atmospheres (ATA) for 90 minutes per session. Pharmacologic treatment utilized Pregabalin or Duloxetine. Patients were evaluated at baseline and 1-3 weeks after the last HBOT session or at 3 months of medication protocol.
The primary endpoint was subjective pain intensity on the visual analogue scale (VAS) and secondary endpoints involved questionnaires determining fibromyalgia symptoms and technetium-99m-methyl-cysteinate-dimmer (Tc-99m-ECD) single photon emission computed tomography (SPECT) brain imaging. Questionnaires included the widespread pain index (WPI), Short Form-36 (SF-36), Medical Outcome Sleep Scale (MOS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory, the Brief Symptom Inventory-18 (BSI-18), global pain scale (GPS), and the fibromyalgia symptoms severity scale (SSS). The conditioned pain modulation (CPM) and pain threshold were also evaluated.
A total of 58 patients were included in the analysis, with no significant differences in baseline symptoms or characteristics reported. A significant group-by-time interaction in pain intensity post HBOT treatment compared with the pharmacological group (d = -0.95, P = 0.001) was observed with a large net effect size in reduction in pain intensity following HBOT compared with those receiving medications. After HBOT, 37.9% of patients no longer met the diagnostic criteria for fibromyalgia compared with 0% in the medication group.
Quality of life improvements and an increase in pain thresholds and were also observed in patients receiving HBOT. FIQ and GPS scores improved with a significant group-by-time interaction in the HOBT group.
Of the 17 patients in the HBOT cohort and 25 patients in the pharmacologic group who underwent all SPECT evaluations, results showed significant group-by-time interactions between HBOT and medication cohorts in the right temporal and left frontal cortex.
Long-term effects of HBOT treatment on patients with fibromyalgia, a chronic disorder, could not be determined. Another limitation was that the comparison group was treated with pharmacologic interventions, rather than a sham-controlled cohort.
“As the neuroscience of fibromyalgia continues to unravel, significant insight is being gained through implementation of additional functional neuroimaging, including functional magnetic resonance imaging (fMRI), Magnetic Electroencephalography (MEG), and Magnetic Resonance Spectroscopy,” investigators concluded. “These techniques allow researchers to shed light on functional brain connectivity patterns in fibromyalgia and may eventually lead to the development of a fibromyalgia—specific pain signature. Obviously, it will be necessary to utilize some of these novel instruments to broaden our understanding regarding the effects of HBOT on nociplastic pain.”