Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial
Shai Efrati, Haim Golan, Yair Bechor, Yifat Faran, Shir Daphna-Tekoah, Gal Sekler, Gregori Fishlev, Jacob N Ablin, Jacob Bergan, Olga Volkov, Mony Friedman, Eshel Ben-Jacob, Dan Buskila, Shai Efrati, Haim Golan, Yair Bechor, Yifat Faran, Shir Daphna-Tekoah, Gal Sekler, Gregori Fishlev, Jacob N Ablin, Jacob Bergan, Olga Volkov, Mony Friedman, Eshel Ben-Jacob, Dan Buskila
Abstract
Background: Fibromyalgia Syndrome (FMS) is a persistent and debilitating disorder estimated to impair the quality of life of 2-4% of the population, with 9:1 female-to-male incidence ratio. FMS is an important representative example of central nervous system sensitization and is associated with abnormal brain activity. Key symptoms include chronic widespread pain, allodynia and diffuse tenderness, along with fatigue and sleep disturbance. The syndrome is still elusive and refractory. The goal of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on symptoms and brain activity in FMS.
Methods and findings: A prospective, active control, crossover clinical trial. Patients were randomly assigned to treated and crossover groups: The treated group patients were evaluated at baseline and after HBOT. Patients in the crossover-control group were evaluated three times: baseline, after a control period of no treatment, and after HBOT. Evaluations consisted of physical examination, including tender point count and pain threshold, extensive evaluation of quality of life, and single photon emission computed tomography (SPECT) imaging for evaluation of brain activity. The HBOT protocol comprised 40 sessions, 5 days/week, 90 minutes, 100% oxygen at 2ATA. Sixty female patients were included, aged 21-67 years and diagnosed with FMS at least 2 years earlier. HBOT in both groups led to significant amelioration of all FMS symptoms, with significant improvement in life quality. Analysis of SPECT imaging revealed rectification of the abnormal brain activity: decrease of the hyperactivity mainly in the posterior region and elevation of the reduced activity mainly in frontal areas. No improvement in any of the parameters was observed following the control period.
Conclusions: The study provides evidence that HBOT can improve the symptoms and life quality of FMS patients. Moreover, it shows that HBOT can induce neuroplasticity and significantly rectify abnormal brain activity in pain related areas of FMS patients.
Trial registration: ClinicalTrials.gov NCT01827683.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
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References
- Clauw DJ, Arnold LM, McCarberg BH. The science of fibromyalgia. Mayo Clin Proc. 2011; 86(9): 907–11. 10.4065/mcp.2011.0206
- Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. 2008; 73(1): 114–20. 10.1016/j.pec.2008.06.005
- Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol. 2011; 7(9): 518–27. 10.1038/nrrheum.2011.98
- Sarzi-Puttini P, Atzeni F, Mease PJ. Chronic widespread pain: from peripheral to central evolution. Best Pract Res Clin Rheumatol. 2011; 25(2): 133–9. 10.1016/j.berh.2011.04.001
- Wolfe F. Fibromyalgianess. Arthritis Rheum. 2009; 61(6): 715–6. 10.1002/art.24553
- Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010; 62(5): 600–10. 10.1002/acr.20140
- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33(2): 160–72.
- Kanaan RA, Lepine JP, Wessely SC. The association or otherwise of the functional somatic syndromes. Psychosom Med. 2007; 69(9): 855–9.
- Matthey A, Cedraschi C, Piguet V, Besson M, Chabert J, Daali Y, et al. Dual reuptake inhibitor milnacipran and spinal pain pathways in fibromyalgia patients: a randomized, double-blind, placebo-controlled trial. Pain Physician. 2013; 16(5): E553–62.
- Goldenberg DL. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry. 2008; 69 Suppl 2: 30–4.
- Guedj E, Taieb D, Cammilleri S, Lussato D, de Laforte C, Niboyet J, et al. 99mTc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia. Eur J Nucl Med Mol Imaging. 2007; 34(1): 130–4.
- Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP, et al. Clinical correlate of brain SPECT perfusion abnormalities in fibromyalgia. J Nucl Med. 2008; 49(11): 1798–803. 10.2967/jnumed.108.053264
- Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002; 46(5): 1333–43.
- Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ. The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. 2005; 52(5): 1577–84.
- Uceyler N, Zeller D, Kahn AK, Kewenig S, Kittel-Schneider S, Schmid A, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain. 2013; 136(Pt 6): 1857–67.
- Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy. J Rheumatol. 2008; 35(7): 1371–7.
- Wood PB, Ledbetter CR, Glabus MF, Broadwell LK, Patterson JC, 2nd. Hippocampal metabolite abnormalities in fibromyalgia: correlation with clinical features. J Pain. 2009; 10(1): 47–52. 10.1016/j.jpain.2008.07.003
- Efrati S, Fishlev G, Bechor Y, Volkov O, Bergan J, Kliakhandler K, et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients—randomized, prospective trial. PLoS One. 2013; 8(1): e53716 10.1371/journal.pone.0053716
- Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, 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 10.1371/journal.pone.0079995
- Boussi-Gross R, Golan H, Volkov O, Bechor Y, Hoofien D, Schnaider Beeri M, et al. Improvement of Memory Impairments in Poststroke Patients by Hyperbaric Oxygen Therapy. Neuropsychology. 2014.
- Bitterman N, Lahat N, Rosenwald T, Kinarty A, Melamed Y, Bitterman H. Effect of hyperbaric oxygen on tissue distribution of mononuclear cell subsets in the rat. J Appl Physiol. 1994; 77(5): 2355–9.
- Bitterman N, Bitterman H, Kinarty A, Melamed Y, Lahat N. Effect of a single exposure to hyperbaric oxygen on blood mononuclear cells in human subjects. Undersea Hyperb Med. 1993; 20(3): 197–204.
- Lee YS, Chio CC, Chang CP, Wang LC, Chiang PM, Niu KC, et al. Long course hyperbaric oxygen stimulates neurogenesis and attenuates inflammation after ischemic stroke. Mediators Inflamm. 2013; 2013: 512978 10.1155/2013/512978
- Lin KC, Niu KC, Tsai KJ, Kuo JR, Wang LC, Chio CC, et al. Attenuating inflammation but stimulating both angiogenesis and neurogenesis using hyperbaric oxygen in rats with traumatic brain injury. J Trauma Acute Care Surg. 2012; 72(3): 650–9. 10.1097/TA.0b013e31823c575f
- Hui J, Zhang ZJ, Zhang X, Shen Y, Gao YJ. Repetitive hyperbaric oxygen treatment attenuates complete Freund's adjuvant-induced pain and reduces glia-mediated neuroinflammation in the spinal cord. J Pain. 2013; 14(7): 747–58. 10.1016/j.jpain.2013.02.003
- Tai PA, Chang CK, Niu KC, Lin MT, Chiu WT, Lin CM. Attenuating experimental spinal cord injury by hyperbaric oxygen: stimulating production of vasculoendothelial and glial cell line-derived neurotrophic growth factors and interleukin-10. J Neurotrauma. 2010; 27(6): 1121–7. 10.1089/neu.2009.1162
- Yildiz S, Kiralp MZ, Akin A, Keskin I, Ay H, Dursun H, et al. A new treatment modality for fibromyalgia syndrome: hyperbaric oxygen therapy. J Int Med Res. 2004; 32(3): 263–7.
- Peach G. Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report. Undersea Hyperb Med. 1995; 22(4): 407–8.
- Tuter NV, Danilov AB, Poliakova LV. [The treatment of a complex regional pain syndrome]. Zh Nevrol Psikhiatr Im S S Korsak. 1997; 97(11): 33–5.
- Kiralp MZ, Yildiz S, Vural D, Keskin I, Ay H, Dursun H. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. 2004; 32(3): 258–62.
- Gu N, Niu JY, Liu WT, Sun YY, Liu S, Lv Y, et al. Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients. Eur J Pain. 2012; 16(8): 1094–105.
- Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache. 1998; 38(2): 112–5.
- Di Sabato F, Rocco M, Martelletti P, Giacovazzo M. Hyperbaric oxygen in chronic cluster headaches: influence on serotonergic pathways. Undersea Hyperb Med. 1997; 24(2): 117–22.
- Dall'Era MA, Hampson NB, Hsi RA, Madsen B, Corman JM. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol. 2006; 176(1): 87–90.
- Yildiz S, Uzun G, Kiralp MZ. Hyperbaric oxygen therapy in chronic pain management. Curr Pain Headache Rep. 2006; 10(2): 95–100.
- Chung E, Zelinski LM, Ohgami Y, Shirachi DY, Quock RM. Hyperbaric oxygen treatment induces a 2-phase antinociceptive response of unusually long duration in mice. J Pain. 2010; 11(9): 847–53. 10.1016/j.jpain.2009.12.004
- Gibbons CR, Liu S, Zhang Y, Sayre CL, Levitch BR, Moehlmann SB, et al. Involvement of brain opioid receptors in the anti-allodynic effect of hyperbaric oxygen in rats with sciatic nerve crush-induced neuropathic pain. Brain Res. 2013; 1537: 111–6. 10.1016/j.brainres.2013.08.050
- Buskila D, Neumann L. Assessing functional disability and health status of women with fibromyalgia: validation of a Hebrew version of the Fibromyalgia Impact Questionnaire. J Rheumatol. 1996; 23(5): 903–6.
- Peveler RC, Fairburn CG. Measurement of neurotic symptoms by self-report questionnaire: validity of the SCL-90R. Psychol Med. 1990; 20(4): 873–9.
- McHorney CA, Ware JE Jr., Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994; 32(1): 40–66.
- McHorney CA, Ware JE Jr., Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993; 31(3): 247–63.
- Neumann L, Berzak A, Buskila D. Measuring health status in Israeli patients with fibromyalgia syndrome and widespread pain and healthy individuals: utility of the short form 36-item health survey (SF-36). Semin Arthritis Rheum. 2000; 29(6): 400–8.
- Jaszczak RJ, Chang LT, Stein NA, Moore FE. Whole-body single-photon emission computed tomography using dual, large-field-of-view scintillation cameras. Phys Med Biol. 1979; 24(6): 1123–43.
- Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005; 9(4): 463–84.
- Petrovic P, Kalso E, Petersson KM, Ingvar M. Placebo and opioid analgesia—imaging a shared neuronal network. Science. 2002; 295(5560): 1737–40.
- Efrati S, Ben-Jacob E. Reflections on the neurotherapeutic effects of hyperbaric oxygen. Expert Review of Neurotherapeutics. 2014.
- Zhang JH, Lo T, Mychaskiw G, Colohan A. Mechanisms of hyperbaric oxygen and neuroprotection in stroke. Pathophysiology. 2005; 12(1): 63–77.
- Gunther A, Kuppers-Tiedt L, Schneider PM, Kunert I, Berrouschot J, Schneider D, et al. Reduced infarct volume and differential effects on glial cell activation after hyperbaric oxygen treatment in rat permanent focal cerebral ischaemia. Eur J Neurosci. 2005; 21(11): 3189–94.
- Chen Z, Ni P, Lin Y, Xiao H, Chen J, Qian G, et al. Visual pathway lesion and its development during hyperbaric oxygen treatment: a bold- fMRI and DTI study. J Magn Reson Imaging. 2010; 31(5): 1054–60. 10.1002/jmri.22142
- Huang L, Obenaus A. Hyperbaric oxygen therapy for traumatic brain injury. Med Gas Res. 2011; 1(1): 21 10.1186/2045-9912-1-21
- Neubauer RA, James P. Cerebral oxygenation and the recoverable brain. Neurol Res. 1998; 20 Suppl 1: S33–6.
- Vlodavsky E, Palzur E, Soustiel JF. Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix metalloproteinase-9 in the rat model of traumatic brain injury. Neuropathol Appl Neurobiol. 2006; 32(1): 40–50.
- Milligan ED, Watkins LR. Pathological and protective roles of glia in chronic pain. Nat Rev Neurosci. 2009; 10(1): 23–36. 10.1038/nrn2533
- Smith HS. Activated microglia in nociception. Pain Physician. 2010; 13(3): 295–304.
- Efrati S, Ben-Jacob E. How and why hyperbaric oxygen therapy can bring new hope for children suffering from cerebral palsy—an editorial perspective. Undersea Hyperb Med. 2014; 41(2): 71–6.
- Etzion Y, Grossman Y. Pressure-induced depression of synaptic transmission in the cerebellar parallel fibre synapse involves suppression of presynaptic N-type Ca2+ channels. Eur J Neurosci. 2000; 12(11): 4007–16.
- Hanlo PW, Gooskens RJ, van Schooneveld M, Tulleken CA, van der Knaap MS, Faber JA, et al. The effect of intracranial pressure on myelination and the relationship with neurodevelopment in infantile hydrocephalus. Dev Med Child Neurol. 1997; 39(5): 286–91.
- Berman S, Abu Hamad R, Efrati S. Mesangial cells are responsible for orchestrating the renal podocytes injury in the context of malignant hypertension. Nephrology (Carlton). 2013; 18(4): 292–8. 10.1111/nep.12043
- Efrati S, Berman S, Goldfinger N, Erez N, Averbukh Z, Golik A, et al. Enhanced angiotensin II production by renal mesangium is responsible for apoptosis/proliferation of endothelial and epithelial cells in a model of malignant hypertension. J Hypertens. 2007; 25(5): 1041–52.
- Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiol Clin. 2012; 30(4): 533–43. 10.1016/j.ccl.2012.07.011
- Mukherjee A, Raison M, Sahni T, Arya A, Lambert J, Marois P, et al. Intensive rehabilitation combined with hyperbaric treatment in children with cerebral palsy: A controlled longitudinal study Undersea Hyperb Med. 2014.
- Efrati S, Ben-Jacob E. Reflections on the neurotherapeutic effects of hyperbaric oxygen. Expert Rev Neurother. 2014; 14(3): 233–6. 10.1586/14737175.2014.884928
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