What Is Fibromyalgia?
Fibromyalgia is a chronic syndrome characterised by widespread musculoskeletal pain, marked tenderness at characteristic pressure points, known as tender points, debilitating fatigue, unrefreshing sleep and frequent cognitive difficulties commonly described as “fibro fog”.
It is not associated with inflammatory findings on routine tests, a fact that for many years led to the mistaken belief that it was a psychosomatic condition.
It primarily affects women between the ages of 30 and 50, although it can occur at any age and in any sex. The clinical presentation is complex and may include muscle pain, joint pain, headaches, irritable bowel syndrome, burning or numb sensations, and substantial impairment of occupational and social functioning.
Management is usually multifaceted and may include medication, physiotherapy, cognitive behavioral therapy and aerobic exercise. A single treatment approach is rarely sufficient.
Characteristics of Fibromyalgia
Fibromyalgia is now understood as a central sensitization disorder. The central nervous system processes sensory signals with heightened sensitivity, leading to a disproportionate perception of pain in response to stimuli that would not normally be painful.
This central sensitisation is associated with neuroinflammation and altered neurotransmitter activity, particularly involving serotonin and substance P.
At muscle level, studies have identified reduced microcirculation and hypoxia in patients with fibromyalgia, findings that may partly explain persistent muscle pain and fatigue.
Muscle ischaemia is not considered the primary cause of the condition, but it may represent an important aggravating factor that sustains and intensifies symptoms.
Scientific Basis
A significant randomized clinical study conducted in Israel evaluated the use of hyperbaric oxygen therapy in patients with fibromyalgia and reported substantial improvements in pain, tender points, fatigue and quality of life after a course of 40 sessions. The outcomes were superior to those observed in the sham-treatment group.
Neuroimaging studies using SPECT also demonstrated improved cerebral blood flow in previously underactive regions, alongside clinical improvement.
These findings suggest that hyperbaric oxygen therapy may act on the underlying pathophysiological mechanisms of fibromyalgia rather than merely relieving symptoms, by improving cerebral oxygenation and reducing the neuroinflammation associated with central sensitization.
The Role of Hyperbaric Oxygen Therapy
In fibromyalgia, hyperbaric oxygen therapy may be used as an adjunctive intervention targeting two principal mechanisms simultaneously: peripheral muscle hypoxia and central neuroinflammation associated with central sensitization.
It does not replace medication or physiotherapy but may act on biological mechanisms that these treatments do not address directly.
Improved muscle microcirculation may reduce the local ischaemia that contributes to persistent muscle pain. Its anti-inflammatory effects may reduce neuroinflammation within the central nervous system, while improved cerebral blood flow may help restore function in regions involved in pain processing.
In addition, stimulation of mitochondrial activity may improve cellular energy production and reduce fatigue.
A typical treatment course consists of 30 to 40 sessions, planned in collaboration with the rheumatologist or physician.