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Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial

PainSci » bibliography » Efrati et al 2015
Tags: treatment, fibromyalgia, chronic pain, pain problems

One page on PainSci cites Efrati 2015: A Rational Guide to Fibromyalgia

PainSci commentary on Efrati 2015: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Hyperbaric oxygen therapy is an experimental, expensive treatment with some promising preliminary evidence for some conditions. The main problem with this intriguing study of HBOT for fibromyalgia is that we have no particular reason think that HBOT is going to be an effective treatment for fibromyalgia specifically. It’s not crazy, but it’s still a substantial speculative leap from “HBOT facilitates neuroplasticity maybe possibly” all the way to “and therefore fibromyalgia cure!”

The whole thing smacks of wishful thinking and perhaps even self-promotion (which is a bit of a plague on HBOT research). Although bias is normal, and nothing actually gets studied if people aren’t keen on it, this is a complex study with a high-risk of bias. These researchers are obviously heavily invested in the idea of HBOT, and the more complicated the study, the more ways there are to unconsciously distort the experiment and its results.

The inclusion of SPECT assessment, while fascinating, adds a bunch more complexity to what is already a complicated trial. Although well-written with good, thorough disclosure of some of the obvious limitations (like the problematic absence of a true placebo control), there’s still way too much wiggle room here, and the results are essentially meaningless without good replication... and probably an (impossible?) solution to the placebo problem. Although the authors think the results were “not likely to be a placebo” and cite a couple reasons why — like the fact that patients actually worsened initially — by no means is that doubt fully resolved.

But there is a bright side: the final results did seem to be quite robust, and they shouldn’t be carelessly dismissed. I just can’t take it too seriously without replication.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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.

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