Fibromyalgia / Chronic Pain Syndrome

Chronic pain, of which Fibromyalgia (FMS) remains a quintessential example has remained one of the most challenging syndromes for modern medicine. FMS is a disorder characterized by musculoskeletal and extensive pain which usually is accompanied by fatigue, sleep, memory, and mood issues. Recent studies found that the syndrome is related to certain malfunctioning regions in the brain which are responsible for pain sensation, pain tolerance, and the ability to process pain signals.

FMS affects 2%-4% of the population and has a significantly negative effect over their quality of life. It is prevalent mostly among females at a ratio of 1:9.

Factors which might Induce Fibromyalgia:

FMS is still not completely understood since there is no single clear-cut event that can cause Fibromyalgia. Yet, in recent years there has been an increase in research of the field which has led to a better understating of the syndrome and concluded that several medical conditions are more likely to induce FMS:   

  1. Traumatic Brain Injury.
  2. Viral Diseases that involve the nervous system – such as Lyme and EBV.
  3. Severe Emotional Stress events.
  4. Sexual Abuse.

Hyperbaric Oxygen Therapy and Fibromyalgia

There is growing data on the physiological effects of Hyperbaric Oxygen Therapy (HBOT) on different injured tissue, including the brain, using different models of preclinical as well as clinical studies. Recently, clinical studies at the Sagol center evaluated the effect of HBOT on patients suffering from neurological deficiencies due to traumatic brain injury and stroke. In these studies, it was found that HBOT can induce neuroplasticity in the metabolic dysfunctions of brain regions even years after the acute insult.  These brain regions can be visualized by metabolic imaging of the brain, done by SPECT analysis combined with MRI. In the regions where there is SPECT/MRI mismatch HBOT can help and induce significant neuroplasticity that is correlated with the related clinical symptoms1-6.

FMS is also part of the ongoing research programs at the Sagol center since it is considered as a representative syndrome of a central sensitization syndrome. The first study conducted in our center was a prospective randomized clinical trial that included 60 patients suffering from Fibromyalgia. The results exhibited that ≈ 70% of patients had significant improvement in all aspects of the syndrome 7. The same improvement with HBOT was demonstrated in a study performed by Yildis et al 8. In addition to the clinical improvement, it was clearly demonstrated that the source of the syndrome relies on abnormal activity in certain brain regions that are responsible for pain sensation 7,9.

An additional clinical study done in our center was focused on FMS patients, in whom the FMS was induced by sexual abuse. This prospective study included 30 patients who have FMS for more than 5 years following the treatment there was a significant improvement in all symptoms that correlated with the improvements seen in the brain imaging 10.

Treating FMS: Sagol Center Recommended HBOT Protocol

Phase I Medical Assessment: The process begins with a comprehensive medical, physiological, cognitive, and imaging evaluation assessment. The tests are conducted by trained medical staff including: Physicians, Neuropsychologists, Physiotherapists, Physiologists, Nurses, and more.

The evaluation also includes metabolic/functional brain imaging: brain perfusion MRI+DTI and brain SPECT in addition to neurocognitive tests and pain laboratory.

Phase II HBOT Protocol: 60 Daily consecutive sessions / 5 days per week / 2 ATA / 100 Oxygen for 90min / Total session time 120min (including 3 airbrakes). At the end of the treatment, the evaluation and tests done at baseline will be repeated for objective evaluation of the change and decision making regarding the future.

*It is important to mention that since HBOT is not a pain killer treatment procedure, but rather is aimed to treat the pathological complexity of the syndrome, some of the patients might experience enhanced clinical symptoms during the first month of the treatment.

  1. Boussi-Gross R, Golan H, Fishlev G, et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PLoS One. 2013;8(11):e79995.
  2. Boussi-Gross R, Golan H, Volkov O, et al. Improvement of memory impairments in poststroke patients by hyperbaric oxygen therapy. Neuropsychology. 2015;29(4):610-621.
  3. Efrati S, Ben-Jacob E. Reflections on the neurotherapeutic effects of hyperbaric oxygen. Expert Rev Neurother. 2014;14(3):233-236.
  4. Efrati S, Fishlev G, Bechor Y, et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients--randomized, prospective trial. PLoS One. 2013;8(1):e53716.
  5. Hadanny A, Tal S, Fishlev G, Bechor Y, Efrati S. Delayed blood-brain barrier disruption after shallow-water diving demonstrated by magnetic resonance imaging. Diving Hyperb Med. 2015;45(2):116-120.
  6. Tal S, Hadanny A, Berkovitz N, Sasson E, Ben-Jacob E, Efrati S. Hyperbaric oxygen may induce angiogenesis in patients suffering from prolonged post-concussion syndrome due to traumatic brain injury. Restor Neurol Neurosci. 2015;33(6):943-951.
  7. Efrati S, Golan H, Bechor Y, et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial. PLoS One. 2015;10(5):e0127012.
  8. Yildiz S, Kiralp MZ, Akin A, et al. A new treatment modality for fibromyalgia syndrome: hyperbaric oxygen therapy. J Int Med Res. 2004;32(3):263-267.
  9. Ablin JN, Efrati S, Buskila D. Building up the pressure on chronic pain. Clin Exp Rheumatol. 2016;34(2 Suppl 96):S3-5.
  10. Hadanny A, Bechor Y, Catalogna M, et al. 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. Front Psychol. 2018;9:2495.