What is fibromyalgia?
In case you never heard about it, fibromyalgia is a condition that characterized by chronic pain and fatigue and a number of common but non-specific symptoms such as chronic widespread pain with concomitant fatigue, sleep disturbance, irritable bowel syndrome, headache, and mood disorders; in addition, cognitive impairments alteration of short-term memory consolidation, speed of information processing, attention span, and multitasking activities.
So, basically, fibromyalgia is a chronic and diffuse musculoskeletal disease affecting prevalently women (9:1 ratio woman/man). It is a serious condition, that can cause severe alteration to everyday life activities. These dysfunctions can start from a bad sleeping schedule and can continue to a decline in work efficiency.
How can we treat it?
Because it is such a complex problem, FM is considered by specialists a multisystem disorder and its treatment is complex. Pharmacological therapy is the main treatment but given its chronicity, non-pharmacological approaches are needed to improve signs and symptoms. Among these, there is behavioral therapy, low-intensity physical exercise, and now low-pressure hyperbaric oxygen therapy.
Until recently it was believed that the most effective treatment was low-intensity physical exercise. However, recent studies are showing different results in regards to low-pressure hyperbaric oxygen therapy effects on FM, making this the most successful treatment for this condition at this moment.
What are exactly the effects of low-pressure HBOT?
The main focus of treating FM is not causing any harmful side effects. Because the patients suffering from fibromyalgia syndrome are already very sensitive, any side effects can be devastating.
The analgesic effects of HBOT have been studied in nociceptive, inflammatory, and neuropathic pain models, and it was demonstrated to be useful for the treatment of various chronic pain syndromes including FM. Five studies that have evaluated the effects of HBOT in FM patients reported improved quality of life, reduced number of tender points, and increased pressure pain threshold, as well as neuroplasticity induction and neuromuscular efficiency. However, high-pressure hyperbaric chambers were used in all these cases, between 2 and 2.5 atmospheres absolute (ATA), involving side effects, such as middle ear or sinus/paranasal barotrauma, or prodromal symptoms of central nervous system toxicity (the latter appearing in less than 50% of cases).
For this reason, new protocols using lower pressure as 1.45 ATA were successfully tested. To have a clear result it was analyzed the effect of low-pressure hyperbaric oxygen therapy on induced fatigue, pain, endurance, and functional capacity, physical performance, and cortical excitability when compared with a physical exercise program in women with FM.
A total of 49 women aged 30–70 years, diagnosed with FM participated in this study.
Participants were not receiving any other rehabilitation or pain treatment intervention as part of the study protocol. All the participants were divided into three groups.
- The first group received low-pressure hyperbaric oxygen treatment, consisting of a total of 40, 90-minute sessions, with five sessions per week. For the prevention of anxiety and irritability, 100% oxygen with air breaks at 1.45 ATA, was used. Oxygen purity at 97% was applied with a mask to the participants inside the hyperbaric chamber.
- The second group was enrolled in a low-intensity physical exercise program using the following protocol: 16 sessions in all, two sessions a week, 60 min each. Exercises were divided into three parts: a 10-minute warm-up, 40 min training, and 10 min cooldown.
- The third group was the control group. Participants assigned to this group received no kind of therapy and were asked to perform their usual routines, that is, to continue with their usual medication, without increasing or lowering the dose (as in all other groups) and if they did any physical activity, they should also continue with this without increasing or reducing it. All assessments were conducted twice, once before the intervention and another after.
“To the best of our knowledge, this is the first experimental study comparing a treatment that requires physical exertion (i.e. physical exercise) against passive treatment (i.e. low-pressure HBOT). Both treatments have been shown to be effective in terms of pain threshold, endurance, functional capacity, and physical performance, with further improvements in HBG in the feeling of fatigue and perceived pain. By contrast, CG showed no improvements in any of the variables studied (p>0.05), and the PPT even dropped at three of the analysed tender points (i.e. occipital area, trapezius, and supraspinatus) in addition to an increase in HR.
Therefore, either treatment could be appropriate to improve the health condition in this population as symptomatology improved. However, given that the physical exercise does not decrease the subjective pain or the feeling of fatigue, unlike what happens with low-pressure HBOT, this might lead to lower adherence to the physical exercise intervention.”
The results suggest that both low-pressure hyperbaric oxygen therapy and an 8-week program of low-impact physical exercise improve pain pressure threshold in some muscles at rest, endurance, and functional capacity, as well as physical performance in daily life activities. Induced fatigue and perceived pain at rest significantly improved only with low-pressure hyperbaric treatment. Thus, low-pressure hyperbaric oxygen treatment may be the treatment of choice in women with FM reporting high levels of pain and fatigue.
Ruth Izquierdo-Alventosa, Marta Inglés, Sara Cortés-Amador, Lucia Gimeno-Mallench, Núria Sempere-Rubio, Javier Chirivella and Pilar Serra-Añó