Overview
HBOT for fibromyalgia has been studied by the Efrati lab in two trials showing significant symptom reduction and measurable changes in brain activity on fMRI. The proposed mechanism involves normalisation of altered pain processing. Not yet UHMS-recognised.
Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, fatigue, cognitive dysfunction ("fibro fog"), sleep disturbance, and often mood symptoms. The underlying pathophysiology involves altered central pain processing and dysregulation of brain regions involved in pain modulation. Standard treatment includes pharmacologic (pregabalin, duloxetine, amitriptyline), exercise, and cognitive-behavioural approaches, with partial efficacy.
HBOT research in fibromyalgia emerged from the hypothesis that altered pain processing might involve brain regions amenable to the perfusion-improving and neuroplasticity-promoting effects of HBOT. The Efrati et al. 2015 trial (PLoS ONE) randomised 60 women with fibromyalgia to HBOT (40 sessions at 2.0 ATA) or standard care. The HBOT group showed significant improvements in pain, cognitive function, and quality of life, along with measurable changes in brain activity on fMRI.
A follow-up study (Hadanny et al. 2019) extended the findings and documented durability of benefit at 6-month follow-up. The results have been clinically influential but have not yet triggered formal UHMS review.
How HBOT Works for This Condition
HBOT may rebalance altered pain-related brain activity in fibromyalgia. The 2015 trial documented fMRI changes in brain regions involved in pain processing (hippocampus, prefrontal cortex) corresponding to clinical improvement. Mechanistic hypotheses include angiogenesis in previously hypoperfused regions, modulation of neuroinflammation, and effects on central pain-processing networks.
GRADE Evidence Rating
Efrati 2015 crossover trial supports symptom + brain-imaging benefit. Single research centre.
| GRADE Domain | Assessment |
|---|---|
| Risk of bias | Moderate |
| Consistency | Single-centre only |
| Directness | Direct |
| Precision | Moderate |
GRADE methodology: Grading of Recommendations Assessment, Development and Evaluation. See GRADE Working Group.
Clinical Protocol
| Typical protocol | 40 sessions at 2.0 ATA |
|---|---|
| Evidence level | Early RCT — Promising |
| FDA status | Not FDA-approved |
Efrati protocol: 40 sessions at 2.0 ATA, 90 minutes each, 5 days per week over 8 weeks.
Evidence Base
The Efrati 2015 trial is methodologically reasonable (randomised, pre-specified outcomes, objective fMRI). Single-centre; replication pending. UHMS Tier 2 (research-stage).
Cautions & Considerations
- Off-label; not covered by US insurance.
- Response variable.
- Not a substitute for established fibromyalgia management (medications, exercise, CBT).
- Standard HBOT contraindications apply.
Key Research & References
- Efrati et al. 2015 (PLoS ONE)
- Hadanny et al. 2019
Indexed Studies for This Condition
Linked entries in the HBOT Studies Database.
Frequently Asked Questions
Will HBOT cure my fibromyalgia?
HBOT is not a cure. The Efrati trials showed significant symptom improvement in approximately 60–70% of participants. Response varies.
Can I continue my fibromyalgia medications?
Yes. HBOT is an adjunct; patients should continue their existing medications unless specifically advised otherwise by their physician.
Research disclaimer: This article summarises published research for educational purposes only. Nothing here is medical advice. HBOT is a prescription medical treatment that must be administered under physician supervision in appropriately certified chambers. Discuss any treatment decisions with a qualified clinician.